Is TNF-α a prognostic factor in patients with sepsis?

Abstract

Objective: To determine tumor necrosis factor-α (TNF-α) levels in a prospective study in 58 hospitalized patients in a department of internal medicine (63 episodes, 29 in immunocompromised patients) during a 7-month period. Methods: Patients fulfilling the following criteria were included: clinical evidence of acute infection, temperature > 38.2°C, tachycardia > 90 beats/min, tachypnea > 20 breaths/min. Samples were taken from day 1 up to day 13 after an infection was diagnosed, and TNF-α was determined by enzyme immunoassay. Results: In 29 episodes (46.0%) the infection was microbiologically documented. The median of the TNF-α levels in the Gram-negative episodes was significantly higher than that in the Gram-positive episodes (p = 0.002). Thirteen of 63 episodes (20.6%) had a fatal outcome. With respect to all measured values, the non-survivors had a significantly higher median of TNF-α levels than the survivors (p = 0.0001). There was, however, great interpatient and intrapatient variability in TNF-α levels; thus, no unequivocal correlation between TNF-α and outcome could be documented. Conclusions: Our data indicate that the influence of the infecting organism on TNF-α kinetics is less pronounced than that of the underlying disease.