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Blister fluid and serum cytokine levels in severe sepsis in humans reflect skin dysfunction
Author(s) -
Koskela M.,
AlaKokko T. I.,
Gäddnäs F.,
Herzig K.H.,
Karhu T.,
Oikarinen A.,
Koivukangas V.
Publication year - 2017
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12771
Subject(s) - medicine , sepsis , suction blister , cytokine , blisters , basic fibroblast growth factor , gastroenterology , inflammation , interleukin 6 , immunology , growth factor , surgery , receptor
Background Knowledge of sepsis‐related end‐organ inflammation in vivo is limited. We investigated the cytokine response in skin and in serum in sepsis and its relation to multiorgan failure ( MOF ) and survival. Methods Cytokines were analysed in serum and in suction blister fluid of intact skin of 44 patients with severe sepsis and 15 healthy controls. Blister fluid and serum samples were collected within 48 h of the first sepsis‐induced organ failure. This is a substudy of a larger follow‐up study on wound healing in sepsis. Results Cytokine levels were higher in patients with sepsis vs. controls (interleukin [ IL ]‐10, blisters: 65.9 vs. 4.3 pg/ml, P < 0.001, serum: 25.7 vs. 4.5 pg/ml, P = 0.004; IL ‐6, blisters: 41.9 vs. 0.03 pg/ml, P < 0.001, serum: 45.5 vs. 2.1 pg/ml, P < 0.001). Patients with MOF had higher levels of IL ‐10 (116.4 vs. 21.3 pg/ml, P = 0.015), IL ‐4 (0.7 vs. 0.07 pg/ml, P = 0.013) and basic fibroblast growth factor ( bFGF ) (25.9 vs. 9.5 pg/ml, P = 0.027) in blister fluid than patients without MOF . In blister fluid, survivors had lower levels of IL ‐10 (43.3 vs. 181.9 pg/ml, P = 0.024) and bFGF (15.8 vs. 31.9 pg/ml, P = 0.006) than non‐survivors. In serum, survivors had higher levels of vascular endothelial growth factor ( VEGF ) (152.2 vs. 14.7 pg/ml, P = 0.012) and lower levels of IL ‐6 (38.5 vs. 91.1 pg/ml, P = 0.011) than non‐survivors. The blister fluid levels of bFGF , TNF and VEGF did not correlate with the serum levels. Conclusions Cytokine responses in skin blister fluid in patients with sepsis differed from those in healthy controls.