Sepsis-associated organ dysfunction and increased supportive care are associated with high serum interleukin-6 levels / Disfunção orgânica associada à sepse e aumento de suporte assistencial relacionados com níveis séricos elevados de interleucina 6

ABSTRACT Introduction: Detection of sepsis and septic shock is essential, since any delay in initiating a proper treatment is associated with a worse prognosis. Objective: To evaluate levels of interleukin-6 (IL-6) early in the onset of the evolution of sepsis associated-organ dysfunction and its relation to the need for more advanced supportive therapies. Methods: This is a prospective study at a 43-bed mixed Medical-surgical Intensive Care Unit (ICU) in a university hospital. Patients admitted to the ICU, over 18 years of age, with severe sepsis or septic shock and who presented the first organ dysfunction in less than 48 hours of admission to the ICU were included. We monitored in a daily basis the advanced supportive therapies, need for vasopressors, mechanical ventilation, or renal replacement therapy (RRT), until hospital discharge or death. Blood samples to measure the serum IL-6 levels were collected at the time of inclusion in the study, at 12 and 24 hours later. Patients were divided into two groups according to serum IL-6 levels at admission (Low IL-6: < 1,000 pg/ml or High IL-6: > 1,000 pg/ml). Results: The need for norepinephrine was significantly higher in the group with High IL-6 (100%) than in the group with Low IL-6 (62.5%) (p = 0.009). RRT was also more frequent in patients with High IL-6 than in those with Low High IL-6 (87.5% vs. 55.5%, respectively, p = 0.056). Conclusion: These findings suggest that the evaluation of serum IL-6 level is useful in the early phase of the severe sepsis and septic shock in order to identify higher-risk patients.

RESUMO Introdução: É primordial identificar a sepse e o choque séptico, uma vez que qualquer atraso no início do tratamento adequado associa-se ao pior prognóstico. Objetivo: Avaliar níveis de interleucina 6 (IL-6) no início da evolução da disfunção orgânica na sepse e sua relação com a necessidade de terapias de suporte avançado. Métodos: Estudo prospectivo em uma unidade de terapia intensiva (UTI) médico-cirúrgica com 43 leitos em um hospital universitário. Pacientes com sepse grave ou choque séptico internados na UTI com idade ≥ 18 anos que apresentaram a primeira disfunção orgânica em menos de 48 horas de admissão na UTI. Foram monitoradas diariamente, até a alta hospitalar ou o óbito, terapias de suporte avançado, necessidade de vasopressores, ventilação mecânica e terapia de substituição renal (TSR). Amostras de sangue para medir os níveis séricos de IL-6 foram coletadas no momento da admissão no estudo, 12 e 24 horas depois. Os pacientes foram divididos em dois grupos de acordo com níveis séricos de IL-6 na admissão (Baixa IL-6: < 1.000 pg/ml ou Alta IL-6: > 1.000 pg/ml). Resultados: A necessidade de norepinefrina foi significativamente maior no grupo com altos níveis de IL-6 (100%) do que no grupo com baixa IL-6 (62,5%) (p = 0,009). TSR também foi mais frequente em pacientes com alta IL-6 do que naqueles com baixa IL-6 (87,5% vs. 55,5%, respectivamente, p = 0,056). Conclusão: Os resultados sugerem que a avaliação dos níveis séricos de IL-6 seja útil na fase inicial do choque séptico e da sepse grave a fim de identificar pacientes de maior risco.

Polymorphisms IL10-819 and TLR-2 are potentially associated with sepsis in Brazilian patients.

Genetic variation in immune response is probably involved in the progression of sepsis and mortality in septic patients. However, findings in the literature are sometimes conflicting or their significance is uncertain. Thus, we investigated the possible association between 12 polymorphisms located in the interleukin-6 (IL6), IL10, TLR-2, Toll-like receptor-4 (TLR-4), tumor necrosis factor-α and tumor necrosis factor-ß (lymphotoxin α--LTA) genes and sepsis. Critically ill patients classified with sepsis, severe sepsis and septic shock and 207 healthy volunteers were analyzed and genotyped. Seven of the nine polymorphisms showed similar distributions in allele frequencies between patients and controls. Interestingly, our data suggest that the IL10-819 and TLR-2 polymorphisms may be potential predictors of sepsis.

Polymorphisms IL10-819 and TLR-2 are potentially associated with sepsis in Brazilian patients

Genetic variation in immune response is probably involved in the progression of sepsis and mortality in septic patients. However, findings in the literature are sometimes conflicting or their significance is uncertain. Thus, we investigated the possible association between 12 polymorphisms located in the interleukin-6 (IL6), IL10, TLR-2, Toll-like receptor-4 (TLR-4), tumor necrosis factor-α and tumor necrosis factor-β (lymphotoxin α - LTA) genes and sepsis. Critically ill patients classified with sepsis, severe sepsis and septic shock and 207 healthy volunteers were analyzed and genotyped. Seven of the nine polymorphisms showed similar distributions in allele frequencies between patients and controls. Interestingly, our data suggest that the IL10-819 and TLR-2 polymorphisms may be potential predictors of sepsis.

Tyrosine: a possible marker of severe intestinal injury during ischemia.

BACKGROUND: Long periods of ischemia can cause organ injury and dysfunction. The protein degradation occurring in the muscular layer and in the mucosa of the intestinal wall during ischemia may release amino acids into the intestinal lumen or into the circulation. The small intestine, like skeletal muscle, cannot synthesize or degrade tyrosine. Thus, the tyrosine concentration released from the gut mucosa reflects the balance between protein synthesis and degradation. We aimed to determine whether tyrosine can be used as a marker of intestinal injury during ischemia. METHODS: In 19 anesthetized rabbits, an ultrasonic flow probe was placed around the superior mesenteric artery to estimate blood flow. A segment from the ileum was isolated using two multilumen catheters with inflated balloons to create a closed segment for perfusion. Animals were allocated into three groups: a sham group without intervention (group I); a group submitted to superior mesenteric artery ligation only (group II); and a group submitted to 1 h of SMA clamping followed by 1 h of reperfusion (group III). Concentrations of lactate and tyrosine (fluorometry) were determined in the serum and the gut luminal perfusate. RESULTS: Gut luminal perfusate tyrosine concentrations increased significantly in group II (from 10 +/- 8 to 93 +/- 63 mm/mL at 2 h) and were significantly higher than in group I (26 +/- 24 mm/mL) and group III (11 +/- 13 mm/mL) (P < 0.05 for all). CONCLUSION: Tyrosine is released from cells into the lumen during severe intestinal ischemia. Regional measurements of tyrosine levels may be a useful indicator of severe intestinal villus compromise.

Motivação da equipe de enfermagem em uma Unidade de Terapia Intensiva / Motivation of the nursing team of a UTI

Trata-se de um estudo descritivo com o objetivo de verificar os fatores motivacionais e desmotivacionais daequipe de enfermagem em uma UTI, abrangendo 68 funcionários, sendo 8 enfermeiros, 11 técnicos e 49auxiliares de enfermagem, sendo que 53 responderam ao questionário com 11 questões fechadas. Verificamosque 45% apresentam-se desmotivados, 100% gostam do que fazem e estão satisfeitos com sua função naunidade, 77% sentem-se estimulados no trabalho, 75% não têm interesse em mudar de setor, 66% se vêemtrabalhando no mesmo lugar e 46% não se sentem reconhecidos como profissional na unidade. Os fatoresdesmotivacionais foram: 21% políticas da empresa, 15,97% salário e benefícios sociais e 11,76% condiçõesfísicas e ambientais de trabalho, e tipo de supervisão. Os fatores motivacionais destacados foram: 29,09%estímulo, desafio no trabalho e realização profissional, 25% exigência de responsabilidade no trabalho e14,55% chance de crescimento profissional e progresso. Sobre os sentimentos dos funcionários antes de irpara o trabalho, 24,65% sentem-se realizados, 23,30% sentem alegria, 20,55% rezam. O relacionamento quepredomina entre eles é 22,22% de cooperação e 17,77% de amizade. Concluiu-se que embora desmotivadose não reconhecidos na unidade, gostam do que fazem, sentem-se satisfeitos, estimulados e não têm interesseem mudar de setor.

One is about a descriptive study with the objective to verify the motivacionais and desmotivacionais factorsof the nursing team of a UTI, being enclosed 68 employees, being 8 nurses, 11 technician and 49 nurse aid,being that 53 had answered to the questionnaire with 11 closed questions. We verify that 45% are presentednot motivated, 100% like the one that make and are satisfied with its function in the unit, 77% are feltstimulated in the work, 75% do not have interest in moving of sector and 66% if it sees working in the sameplace, 46% not if they feel recognized as professional in the unit. The desmotivacionais factors had been:21% politics of the company, 15.97% wage and social benefits and 11.76% physical and ambient conditionsof work and type of supervision. The detached motivacionais factors had been: 29.09% stimulation, challengein the work and professional accomplishment, 25% requirement of responsibility in the work, 14.55% possibilityof professional growth and progress. About the feelings of the employees before going for the work, 24.65%are felt carried through, 23.30% joy. The relationship that predominates between them, 22.22% cooperation,17.77% friendship. We conclude that even so not motivated and not recognized in the unit, they like the onethat makes, are felt satisfied, stimulated and do not have interest in moving of sector.