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Louis Y. A. Chai, Mihai G. Netea, Steven Teerenstra, Arul Earnest, Alieke G. Vonk, Haran T. Schlamm, Raoul Herbrecht, Peter F. Troke, Bart-Jan Kullberg, Early Proinflammatory Cytokines and C-Reactive Protein Trends as Predictors of Outcome in Invasive Aspergillosis, The Journal of Infectious Diseases, Volume 202, Issue 9, 1 November 2010, Pages 1454–1462, https://doi.org/10.1086/656527
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Abstract
Background. Monitoring treatment response in invasive aspergillosis is challenging, because an immunocompromised host may not exhibit reliable symptoms and clinical signs. Cytokines play a pivotal role in mediating
host immune response to infection; therefore, the profiling of biomarkers may be an appropriate surrogate for disease status.
Methods. We studied, in a cohort of 119 patients with invasive aspergillosis who were recruited in a multicenter clinical trial, serum interleukin (IL)-6, IL-8, IL-10, interferon-γ, and C-reactive protein (CRP) trends over the first 4 weeks of therapy and correlated these trends to clinical outcome parameters.
Results. Circulating IL-6 and CRP levels were high at initiation of therapy and generally showed a downward trend with antifungal treatment. However, subjects with adverse outcomes exhibited a distinct lack of decline in IL-6 and CRP levels at week 1, compared with responders (P=.02, for both IL-6 and CRP). Nonresponders also had significantly elevated IL-8 levels (P=.001).
Conclusions. High initial IL-8 and persistently elevated IL-6, IL-8, and CRP levels after initiation of treatment may be early predictors of adverse outcome in invasive aspergillosis. Cytokine and CRP profiles could be used for early identification of patients with a poor response to antifungal treatment who may benefit from more aggressive antimicrobial regimens.
