The impact of time on the systemic inflammatory response in pneumococcal

The aim of our study was to analyse the impact of time from onset of symptoms on the systemic cytokine concentrations in patients with pneumococcal pneumonia. Adults with severe pneumococcal pneumonia were prospectively included. At admission, vital signs, time from onset of pneumonia symptoms and circulating levels of C-reactive protein (CRP), serum amyloid A (SAA), tumour necrosis factor (TNF)-a, and interleukin (IL)-1b, IL-6, IL-8, IL-10 and IL-1ra were recorded. 32 patients were included; 13 patients had ,48 h of evolution and 19 patients had been sick for .48 h. The group with a longer time of evolution presented higher plasmatic levels of TNF-a (19.1i8.5 versus 35.5i26 pg?mL -1 ), fibrinogen (6i1.8 versus 9i2); CRP (130i85 versus 327i131) and SAA (678i509 versus 984i391). Concentrations of TNF-a were associated with the presence of bacteraemia, initial blood pressure ,90 mmHg and with a lower oxygen saturation at admission. Likewise, TNF-a levels were correlated with concentrations of IL-1b (r50.49), IL-6 (r50.41) and IL-8 (r50.40). In pneumococcal pneumonia, patients with a longer time of evolution presented with higher levels of pro-inflammatory cytokines and a higher expression of acute phase proteins, suggesting a sustained release of pneumococcal antigens over time.