Cytokine Profile In Elderly Patients with Sepsis

Anil T. Kumar, U. Sudhir, K. Punith, Rahul Kumar, V. N. Ravi Kumar, and Medha Y. Rao

Pembimbing : Prof. DR. dr. H. A. Guntur Hermawan, SpPD-KPTI, finasim

Oleh : Dwinita Vivianti

PENDAHULUAN
Sepsis merupakan respon host terhadap infeksi sistemik Sepsis menjadi kondisi yang penting dalam pentalaksanaan pasien dengan kondisi akut terutama pasien dengan umur diatas 60 tahun Studi tentang sepsis berkembang ke arah marker, hingga 80 marker sepsis terbanyak TNF- dan IL-6
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 Penelitian ini bertujuan untuk menemukan hubungan antara marker TNF dan IL-6 dengan angka kematian pada geriatri dengan sepsis yang dilakukan penelitian secara serial

MATERIAL AND METHODS

Waktu dan Tempat Subjek Penilaian Analisa statistik
Tertiary care centre April 2007 September 2008

Inklusi : >60 th; memenuhi kriteria SIRS&MODS; pneumonia dan sputum purulen; resiko tinggi infeksi Eksklusi :HIV; keganasan; peny.autoimun; post transplant, CKD, ch. Liver dis,pankreatitis

skor APACHE II TNF- dan IL-6 day 1, 3, 7 sanwich ELISA technique

SPSS for Window 11.0 student paired t test, ANOVA p < 0,05 signifikan

HASIL

Figure 1 Correlation of IL-6 values on day 1, day 3 and day 7 among survivors and nonsurvivors subgroups of the male subset using the twoway ANOVA test. In survivor group, there is a significant decrease in the level of IL-6 from day 1 to day 7, whereas there is no 9 significant change in the values in the nonsurvivor group

Figure 2 Correlation of IL-6 values on day 1, day 3 and day 7 among survivors and non-survivors subgroups of the female subset using the twoway ANOVA test. In the survivor group, there is a significant decrease in the levels of IL-6 from day 1 to day 7, whereas in the 10 nonsurvivor group, there is an increase in the IL-6 values over the same study period

DISKUSI
Profil sitokin pada pasien dengan sepsis berat berguna untuk memprediksi mortalitas dan manajemen yang lebih baik dari sepsis Menurunnya IL-6 prognosis baik Gogos et al higher levels of TNF-a, IL-6, were detected in patients with an early hemodynamic deterioration.

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 A significant decrease IL-6 levels was observed over the study period in the survivor group only (p < 0.05) Presterl et al Marti et al. higher level of IL-6 higher mortality Oberholzer et al IL-6 good in augmenting prognostic score and predicting outcome Bozza et al. higher values of Kellum et al. and IL-6 were predictive higher mortality and organ dysfunction Kellum et al. higher concentrations of IL-6 admission were predictive of higher mortality
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 Pada penelitian ini didapatkan angka kematian pada wanita lebih tinggi dari laki-laki Eachempati et al Schroder et al. dan Adrie et al. sebaliknya Banyak kriteria yang dapat mempengaruhi outcome sepsis, ex : hormon, sosial, lingkungan, ekonomi, dan personal healthrelated activity
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 TNF- rendah (<10) pada perjalanan penyakit pasien wanita berhubungan dengan peningkatan angka kematian

Imhara et al. dan Moxley et al.

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KESIMPULAN
Profil sitokin dari level TNF- dan IL-6 pada pasien geriatri membantu penentuan prognosis Female independent predictor

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TERIMA KASIH
MATUR NUWUN

2000: BASIC CONCEPTS ON SEPSIS

(Guntur)
C3a, C5a

LPS
LBP CD 14

APC
MHC II

C7a

Super Antigen TCR

TH - 2

TLR 4
TLR2
IFN - K

CD 4+
TH - 1

IL - 10 IL -4 IL - 5

IL- 6 ILIL- 6 ILTNF - E PGE 2

IL 8 IL -1

CSF ILnetrofil IL-2

Compl.

B cell

Ig
NK
netrofil

CD 8+

NO

ICAM -1

netrofil

A. Guntur H. (Perdici 2006)

LPS
ENDOTOKSIN

TLR4 CD14
My D88 IRAK TRAF6 NFNF-KB MDMD-2

Target Genes

M*

CYTOKINES

TNF-E
A. Guntur H. (Perdici 2006)

2002 : IL-6 as Anti-inflammatory ILAnti(Takala et al.)

2004 : IL-6 is not included as proinflammatory and ILalso antiinflammatory cytokines

(Carrigan et al.,).

bacterial viral fungal

Cardiac surgery

sepsis

Asphyxia/Hypoxia Systemic inflammatory Trauma and burns response (SIRS) Neonatal lung affectionS

parasital
Severe sepsis or SIRS

others

shock

Others
(Bone,1992)

Infective cause

Noninfective cause

ROLE OF CYTOKINES IL1,TNFE IL1,TNFE, IL6, IL8, IL-10 ILnetrofil

ENDOTHEL

(Guntur 2000)

Role of Response Immune in Sepsis

Proinflammatory Response IL-1, IL-6, TNF-E IL- IL- TNF-

AntiAnti-inflammatory Response IL-10, IL-4, IL-1ra ILIL- ILMARS

Mixed Antagonist Response Syndrome

Hyperinflammatory Status SIRS

Systemic Inflamatory Response Syndrome

Anti-inflammatory Status CARS

Compensatory Anti-inflammatory Response Syndrome

Cardiovascular compromise (shock) Apoptosis - Necrosis Organ dysfunction (MODS/MOF)

Suppression of the Immune System