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We appreciate the efforts of Matera and colleagues' study establishing the utility of IL-10 as a diagnostic and prognostic marker of early sepsis [1]; however, we have some concerns.  Limiting the study to the surgical population limits the generalizability. More importantly, inclusion of 28 (of the 52) patients after on-pump cardiac surgery is concerning. Pump surgery is widely accepted to result in an intense surge in inflammatory markers, including IL-10 [2]. Also, the duration of pump surgery can be variable and the inflammatory response varies with the time spent on pump. The association of IL-10 with a worse prognosis (nonsurvivor group) may therefore not be valid. Cardiac ICU protocols such as the use of perioperative antibiotics were not discussed, which may affect mortality.  In Table 3 of their article, the confidence interval for the odds ratio of IL-10 for the prognosis of bacteremic systemic inflammatory response syndrome patients includes the value 1 [1]. Including this value limits the applicability. The values of biomarkers were not checked daily, and therefore we cannot rule out a new increase in the levels of IL-10 secondary to subsequent episodes of inflammation [3]. The Sequential Organ Failure Assessment score and IL-10 values on day 1 and day 7 correlate with mortality. The utility of an expensive and time-consuming biomarker is questioned when a simple, quick and bedside test could predict the outcome.  Despite the positive results of the marker, it is difficult to imagine how such information would change management in the era of the surviving sepsis guidelines [4].

IL-10: a marker of cardiac bypass?