Open Access

ARTICLE

High cytokine levels at admission are associated with fatal outcome in patients with necrotizing fasciitis

Kathrin Lungstras-Bufler¹, Philip Bufler¹, Rabiatu Abdullah², Christine Rutherford², Stefan Endres³, Edward Abraham¹, Charles A. Dinarello¹, Robert M. Rodriguez²

1 University of Colorado, Health Sciences Center, Denver, CO
2 Department of Emergency Medicine, Highland General Hospital, Oakland, CA
3 Abteilung für Klinische Pharmakologie, Klinikum der Ludwig-Maximilians-Universität Munich, Germany

* Corresponding Author: Charles A. Dinarello,

European Cytokine Network 2004, 15(2), 135-138.

Accepted 16 February 2004;

Abstract

We evaluated in a blinded fashion the cytokine profiles of patients with suspected necrotizing fasciitis. In 15 out of 20 patients, the diagnosis of necrotizing fasciitis was established; five patients had cellulitis. Eighteen of the 20 patients were i.v. drug users. Five of the 15 patients with necrotizing fasciitis died (33%). On admission, serum levels for interleukin-1β (IL-1β), IL-1-receptor antagonist (IL-1Ra), IL-18 and interferon-γ (IFNγ) as well as white blood cells (WBC) were significantly elevated in patients with fatal outcome compared to survivors with necrotizing fasciitis. IL-1Ra and WBC levels were also higher than in patients with cellulitis. No differences were observed between patients groups for IL-6 and IL-8. In summary, significantly elevated levels of proinflammatory cytokines and particularly IL-1Ra are associated with fatal outcome in patients with necrotizing fasciitis. The measurement of proinflammatory cytokines and IL-1Ra may help to establish early diagnosis of life-threatening necrotizing fasciitis and thus to initiate aggressive treatment.

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