ABSTRACT
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, IL8, IL10, interferonγ, and Creactive protein (CRP) trends over the first 4 weeks of therapy and correlated these trends to clinical outcome parameters. RESULTS: Circulating IL6 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 IL6 and CRP levels at week 1, compared with responders (P = .02, for both IL6 and CRP). Nonresponders also had significantly elevated IL8 levels (P = .001). CONCLUSIONS: High initial IL8 and persistently elevated IL6, IL8, 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 moreaggressive antimicrobial regimens.