Perfil das citocinas na Endocardite Infecciosa

Abstract

Background Infective endocarditis (IE) is a severe disease associated with a high mortality rate despite recent advances in its diagnosis and treatment. Cytokines, serum inflammatory mediators, may contribute to the diagnosis and management of IE. The aim of the present study was to determine serum cytokine concentrations in patients with IE and to compare the levels of these markers with healthy subjects and a group of patients with non-IE infections. Methods Eighty-one patients with definite IE according to Duke´s Criteria were enrolled between January 2005 and May 2013 in University Hospital, Federal University of Minas Gerais. Serum samples of all patients were obtained within the first week of admission to assess the concentrations of several cytokines. In order to explore the profile of cytokines in different infectious processes, two control groups were selected. The first group consisted of 34 healthy individuals who are volunteers, and the second group was comprised of 30 patients with non-IE infections. Serum samples from patients with IE and from controls were analyzed for the following markers: interleukin (IL) 1β, IL-6, IL-8, IL-10, IL-12 and tumor necrosis factor-α (TNF-α). Cytokine concentrations were measured by cytometric bead array (CBA). Results Mean age of IE was 47 ± 17 years (range, 15 - 80 years), and 40 (49%) individuals were male. The most common underlying heart disease was the presence of valvular prosthesis (33.3%). The main causative microorganisms were staphylococci (19.7%). Culture-negative endocarditis occurred in 44 patients (54%). Except for IL-12, patients with IE had significantly higher serum concentrations of the mediators than healthy volunteers’ serum. Median of IL -1β, TNF-α and IL-12 serum levels were significantly higher in IE patients than in patients with non-IE infections. When IE group was stratified according to the infecting microorganism, serum concentrations of TNF-α and IL-12 were significantly higher in staphylococcal IE subgroup than in the non-staphylococcal IE group. Conclusions Cytokines were elevated in the IE in comparison to healthy controls. Median IL-1β, TNF-α and IL-12 serum levels were significantly higher in IE than in non-IE infections. Lower IL-10 production occurred in staphylococcal IE, compared to non-staphylococcal IE and an elevated prevalence of higher producers of IL-1β, TNF-α and IL-12 was observed only in staphylococcal subgroup.