(1418) Differential Cytokine Profiles of Adult and Pediatric Patients With Sepsis

Introduction: Sepsis continues to be a leading cause of death in both adult and pediatric ICU patients. Numerous clinical trials have likely failed due to heterogeneity within the sepsis population. We hypothesized that adult and pediatric sepsis patients would demonstrate different cytokine profiles.

Methods: We performed a single-center, prospective cohort study examining both pediatric and adult critically ill patients admitted to the Hershey Medical Center with sepsis. Pediatric patients (0–17 years old) or adults (>17 years old) who fulfilled sepsis criteria (presumed or suspected infection and one or more organ dysfunction) were eligible for enrollment. Informed consent was obtained prior to enrollment in the two separate, IRB-approved, studies. Cytokines were measured in plasma by ELLA automated immunoassay system using simpleplex assays.

Results: A total of eighty-seven (87) patients were enrolled, sixty-nine (69) adults and eighteen (18) pediatric patients. The adult cohort appeared more critically ill at enrollment: the calculated risk of mortality (ROM) of the adult cohort was 42.4% based on APACHE scoring; while ROM was only 12.7% in the pediatric cohort based on PRISM-III scoring. Actual mortality (28-day) was 26.2% in the adult cohort and 18.2% in the pediatric patients. Cytokine levels were significantly higher in pediatric patients in 9 of the 14 cytokines analyzed. TNFR1 and IL-8 most closely associated with 28-d mortality in adult patients, whereas CCL3 was associated with mortality in pediatric patients.

Conclusions: Adult and pediatric patients with sepsis demonstrate different cytokine patterns at the onset of sepsis. This study demonstrates that the immune dysregulation that defines sepsis may differ significantly between pediatric and adult patients. It follows that these populations may respond differently to immune modulators in future studies of the treatment of sepsis.