Présentation
Circulating cytokines and chemokines(Cavaillon et al. Scand. J. Infect. Dis. 2003, 35, 535)
The presence within the blood stream of cytokines with pro- or anti-inflammatory properties is a hallmark of the systemic inflammation occurring in sepsis patients. Surprisingly, we showed that the levels of the chemokine RANTES (or CCL5) were inversely correlated with APACHE II severity score and outcome: in contrast to all cytokines reported so far, high levels of circulating RANTES correlated with a better prognosis. Most probably, these levels are linked to the number of platelets that are a major source of RANTES.
Enhanced plasma levels of soluble triggering expressed on myeloid cells-1 (sTREM-1) and procalcitonin (PCT) after cardiac surgery and cardiac arrest in the absence of infection (Adib-Conquy et al. Shock 2007, 28, 406)
Soluble Triggering Expressed on Myeloid Cells-1 (sTREM-1) and Procalcitonin (PCT) have been claimed to be specific markers of infection. We decided to evaluate the plasma levels of sTREM-1 and PCT in non-septic etiologies of systemic inflammatory response syndrome. Plasma s-TREM-1 and PCT were determined in 76 non-infected patients undergoing an elective heart surgery with cardiopulmonary-bypass, 54 patients admitted after an out-of-hospital cardiac arrest, 55 patients with a severe sepsis and 31 healthy volunteers. We found a plasma sTREM value above the suggested threshold for sepsis in 58% cardiac surgery patients, 56% cardiac arrest patients, and 78 % septic patients. Plasma PCT values above the suggested threshold of 0.5 µg/l for sepsis were found in 33% cardiac surgery patients, 80% cardiac arrest patients, and 96% severe sepsis patients. Levels of sTREM-1 and PCT were significantly higher in cardiac arrest patients who died by a refractory shock than those dying from neurological damages or those surviving without major neurological sequalae. In the group of cardiac arrest patients with a refractory shock, levels of sTREM-1 and PCT were similar to that observed in severe sepsis patients. Thus, we established that sTREM-1 and PCT are not specific markers of infection, and are significantly increased in some acute inflammatory non-infectious situations.