Clinical aspects and cytokine response in severe H1N1 influenza A virus infection.

Authors: Hagau, N  Slavcovici, A  Gonganau, DN  Oltean, S  Dirzu, DS  Brezoszki, ES  Maxim, M  Ciuce, C  Mlesnite, M  Gavrus, RL  Laslo, C  Hagau, R  Petrescu, M  Studnicska, DM 
Citation: Hagau N, etal., Crit Care. 2010;14(6):R203. Epub 2010 Nov 9.
Pubmed: (View Article at PubMed) PMID:21062445
DOI: Full-text: DOI:10.1186/cc9324

ABSTRACT : INTRODUCTION : The immune responses in patients with novel A(H1N1) virus infection (nvA(H1N1)) are incompletely characterized. We investigated the profile of Th1 and Th17 mediators and interferon-inducible protein-10 (IP-10) in groups with severe and mild nvA(H1N1) disease and correlated them with clinical aspects. METHODS : Thirty-two patients hospitalized with confirmed nvA(H1N1) infection were enrolled in the study: 21 patients with nvA(H1N1)-acute respiratory distress syndrome (ARDS) and 11 patients with mild disease. One group of 20 patients with bacterial sepsis-ARDS and another group of 15 healthy volunteers were added to compare their cytokine levels with pandemic influenza groups. In the nvA(H1N1)-ARDS group, the serum cytokine samples were obtained on admission and 3 days later. The clinical aspects were recorded prospectively. RESULTS : In the nvA(H1N1)-ARDS group, obesity and lymphocytopenia were more common and IP-10, interleukin (IL)-12, IL-15, tumor necrosis factor (TNF)alpha, IL-6, IL-8 and IL-9 were significantly increased versus control. When comparing mild with severe nvA(H1N1) groups, IL-6, IL-8, IL-15 and TNFalpha were significantly higher in the severe group. In nonsurvivors versus survivors, IL-6 and IL-15 were increased on admission and remained higher 3 days later. A positive correlation of IL-6, IL-8 and IL-15 levels with C-reactive protein and with > 5-day interval between symptom onset and admission, and a negative correlation with the PaO2:FiO2 ratio, were found in nvA(H1N1) groups. In obese patients with influenza disease, a significant increased level of IL-8 was found. When comparing viral ARDS with bacterial ARDS, the level of IL-8, IL-17 and TNFalpha was significantly higher in bacterial ARDS and IL-12 was increased only in viral ARDS. CONCLUSIONS : In our critically ill patients with novel influenza A(H1N1) virus infection, the hallmarks of the severity of disease were IL-6, IL-15, IL-8 and TNFalpha. These cytokines, except TNFalpha, had a positive correlation with the admission delay and C-reactive protein, and a negative correlation with the PaO2:FiO2 ratio. Obese patients with nvA(H1N1) disease have a significant level of IL-8. There are significant differences in the level of cytokines when comparing viral ARDS with bacterial ARDS.

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CRRD ID: 5128683
Created: 2011-03-15
Species: All species
Last Modified: 2011-03-15
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RGD is funded by grant HL64541 from the National Heart, Lung, and Blood Institute on behalf of the NIH.