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

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...

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Published in:	Critical care (London, England) Vol. 14; no. 6; p. R203
Main Authors:	Hagau, Natalia, Slavcovici, Adriana, Gonganau, Daniel N, Oltean, Simona, Dirzu, Dan S, Brezoszki, Erika S, Maxim, Mihaela, Ciuce, Constantin, Mlesnite, Monica, Gavrus, Rodica L, Laslo, Carmen, Hagau, Radu, Petrescu, Magda, Studnicska, Daniela M
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 01-01-2010 BioMed Central
Subjects:	Adolescent Adult Aged Cytokines - biosynthesis Cytokines - blood Development and progression Epidemics Female Humans Immune response Influenza A virus Influenza A Virus, H1N1 Subtype - immunology Influenza, Human - blood Influenza, Human - immunology Interferon Male Medical research Medicine, Experimental Middle Aged Prospective Studies Severity of Illness Index Swine influenza Young Adult
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Summary:	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. 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. In the nvA(H1N1)-ARDS group, obesity and lymphocytopenia were more common and IP-10, interleukin (IL)-12, IL-15, tumor necrosis factor (TNF)α, 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 TNFα 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 PaO(2):FiO(2) 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 TNFα was significantly higher in bacterial ARDS and IL-12 was increased only in viral ARDS. 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 TNFα. These cytokines, except TNFα, had a positive correlation with the admission delay and C-reactive protein, and a negative correlation with the PaO(2):FiO(2) 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	1364-8535 1466-609X 1364-8535
DOI:	10.1186/cc9324