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Association of Proinflammatory Molecules with Apoptotic Markers and Survival in Critically Ill Multiple Organ Dysfunction Patients

School of Nursing at the University of Athens, Greece, elipapa{at}nurs.uoa.gr

Jan A. Moynihan, PhD

Departments of Psychiatry, Microbiology and Immunology, and Oncology at the University of Rochester Medical Center, Rochester, NY

Ourania Dafni, PhD

School of Nursing at the University of Athens, Greece

Christos S. Mantzoros, MD, PhD, MSc

Beth Israel Deaconess Medical Center, Harvard Medical School, Boston

Michael H. Ackerman, DNS, RN, CS, FCCM

School of Nursing at the University of Rochester, Rochester, NY

Recent evidence supports the involvement of apoptosis in multiple organ dysfunction (MODS). The authors examined the hypothesis that nitric oxide (NO), interleukin (IL)-6, tumor necrosis factor (TNF)-, and cortisol correlate with Fas and Fas ligand (FasL) expression on peripheral blood mononuclear cells and that Fas and FasL, therefore, mediate their association with MODS severity. Thirty-five critically ill adult MODS patients were followed for up to 14 days and were compared to non-MODS matched controls. Fas, FasL, nitrate, cortisol, and IL-6 were elevated in MODS patients (P < 0.05). Nitrate and cortisol correlated with Fas expression (P < 0.05). All factors studied, except for TNF-, correlated with MODS severity (P < 0.05); however, by multivariate analyses, Fas and FasL were independently associated with severity and survival (P < 0.05). The inflammatory molecules studied may mediate the association of apoptotic constituents with MODS severity and survival only in part.

Key Words: MODS • apoptosis • Fas • cytokines • nitric oxide • cortisol • interleukin-6 • tumor necrosis factor-

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