[Dynamics of interleukin 6 levels in the patients with cardiogenic and septic shock and in a control group of patients with uncomplicated AMI]. / Dynamika hladiny interleukinu 6 u pacientu v septickém a kardiogenním soku a u pacientu s akutním infarktem myokardu s elevacemi ST.

INTRODUCTION: Cardiogenic shock (CS) is the leading cause of mortality in patients with acute myocardial infarction (AMI). Inflammatory response seems to be common response in patients with AMI, especially those with CS. We have therefore conducted a study to determine diagnostic and prognostic utility of interleukin 6 (IL6) levels in the cohort of patients with cardiogenic and septic shock (SS) and in a control group of patients with uncomplicated AMI. METHODS: In this prospective study 71 patients fulfilled the inclusion criteria: 30 patients with cardiogenic shock, 21 patients with septic shock and 20 patients with ST elevation myocardial infarction (STEMI). Plasma levels of IL6 were measured at 8 time points. The main endpoint was 3 month mortality. RESULTS: We have shown that the highest IL6 levels during the first week were recorded in patients with septic shock with peak value at admission. The maximum level of IL6 was detected between 12 to 24 hours after the onset of MI among patients with cardiogenic shock. According to Receiver operating characteristic (ROC) statistics levels of IL6 > 357 pg/ml at admission (AUC 0.730, p = 0.031) were typical for patients with CS in comparison with control group of STEMI patients. Values of IL6 > 1 237 pg/ml at admission and > 1 071 pg/ml at 24 hours (after admission?) were typical for thouse in septic shock in comparison with CS patients. We found only a non-significant trend of IL6 for the prediction of mortality in the cohort of CS patients for levels 1 854 pg/ml (AUC 0.769, p = 0.066) sampled 12 hours after admission. There was no association of plasma levels of IL6 with mortality in septic shock patients. CONCLUSIONS: Patients with cardiogenic shock demonstrated more pronounced cytokine response as evidenced by increased levels of IL6 compared to patients with uncomplicated STEMI. Levels of IL6 peaked in SS patients at admission, in CS patients 12-24 hours after admission. In daily clinical practice routine measurement of IL6 levels for prediction of prognosis both in cardiogenic and septic shock are of little value mainly due to significant interindividual variability of IL6 values.

Bilateral changes in IL-6 protein, but not in its receptor gp130, in rat dorsal root ganglia following sciatic nerve ligature.

Local intracellular signaling cascades following peripheral nerve injury lead to robust axon regeneration and neuropathic pain induction. Cytokines are classic injury-induced mediators. We used sciatic nerve ligature (ScNL) to investigate temporal changes in IL-6 and its receptor gp130 in both ipsilateral and contralateral lumbal (L4-L5) dorsal root ganglia (DRG). Rats were operated aseptically on unilateral ScNL and allowed to survive for 1, 3, 7, and 14 days. Immunohistochemistry and Western blot analysis were used to determine levels of IL-6 and gp130 in DRG. A distinct increase in immunostaining for IL-6 was found in the neuronal cell bodies of sections through both ipsilateral and contralateral DRG at 1 and 3 days after operation. After 7 and 14 days, the DRG sections displayed only a moderate elevation in immunostaining when compared with sections of naïve DRG. The levels of IL-6 protein increased in both ipsilateral and contralateral lumbal DRG following peripheral nerve injury. The elevation of IL-6 protein was significant in both ipsilateral and contralateral DRG 1, 3, 7, and 14 days after operation. On the other hand, the levels of gp130 receptor did not change significantly. The data provide evidence for changes in IL-6 levels not only in the DRG associated with the damaged nerve but also in those unassociated with nerve injury during the experimental neuropathic pain model.