Early proinflammatory cytokines and C-reactive protein trends as predictors of outcome in invasive aspergillosis
Background. Monitoring treatment response in invasive aspergillosis is challenging, because an immunocompromised host may not exhibit reliable symptoms and clinical signs. Cytokines play a pivotal role in mediating host immune response to infection; therefore, the profiling of biomarkers may be an appropriate surrogate for disease status. Methods. We studied, in a cohort of 119 patients with invasive aspergillosis who were recruited in a multicenter clinical trial, serum interleukin (IL)-6, IL-8, IL-10, interferon-γ, and C-reactive protein (CRP) trends over the first 4 weeks of therapy and correlated these trends to clinical outcome parameters. Results. Circulating IL-6 and CRP levels were high at initiation of therapy and generally showed a downward trend with antifungal treatment. However, subjects with adverse outcomes exhibited a distinct lack of decline in IL-6 and CRP levels at week 1, compared with responders (P = .02, for both IL-6 and CRP). Nonresponders also had significantly elevated IL-8 levels (P = .001). Conclusions. High initial IL-8 and persistently elevated IL-6, IL-8, and CRP levels after initiation of treatment may be early predictors of adverse outcome in invasive aspergillosis. Cytokine and CRP profiles could be used for early identification of patients with a poor response to antifungal treatment who may benefit from more-aggressive antimicrobial regimens. © 2010 by the Infectious Diseases Society of America. All rights reserved.
|Keywords||C reactive protein, adult, adverse outcome, amphotericin B, article, clinical assessment, clinical trial, cohort analysis, controlled clinical trial, controlled study, cytokine, drug efficacy, female, gamma interferon, human, interleukin 10, interleukin 6, interleukin 8, invasive aspergillosis, major clinical study, male, multicenter study, prediction, priority journal, protein blood level, randomized controlled trial, treatment outcome, voriconazole|
|Persistent URL||dx.doi.org/10.1086/656527, hdl.handle.net/1765/22099|