Inflammatory cytokine and nitric oxide responses in pediatric sepsis and organ failure

Crit Care Med. 1996 Jul;24(7):1137-43. doi: 10.1097/00003246-199607000-00012.


Objective: To examine the relationship of circulating proinflammatory and anti-inflammatory cytokine concentrations to nitric oxide and organ failure in pediatric sepsis.

Design: Prospective study.

Setting: Pediatric intensive care unit (ICU), children's Hospital of Pittsburgh, University of Pittsburgh.

Patients: Nineteen patients with a diagnosis of sepsis admitted to the pediatric ICU. Twelve uninfected critically iII patients served as controls.

Interventions: None.

Measurements and main results: Plasma interleukin (IL)-10, IL-6, and nitrite/nitrate concentrations were measured and compared with an index of organ failure daily for 3 days after presentation with the sepsis syndrome. Children with increased plasma IL-6 concentrations (n = 6) had increased plasma nitrite/nitrate concentrations (p < 0.01 on each day), increased organ failure scores (p < .05 on days 1 and 3), and the highest plasma IL-10 concentrations (p < .05 on days 1 and 3, p = .054 on day 2) when compared with children with sepsis and undetectable IL-6 concentrations. Children with sepsis and detectable IL-6 concentrations, and children with undetectable IL-6 concentrations, both had increased nitrite/nitrate concentrations (p < .005 on days 1 through 3) and increased IL-10 concentrations (p < .05 on days 1 and 2) compared with controls. Children with increased IL-6 concentrations had higher organ failure on each day (p < .01), and children with undetectable IL-6 concentrations had higher organ failure on days 1 and 2 only (p < .005) when compared with controls. Organ failure improved over time in the children with undetectable IL-6 concentrations (p < .005).

Conclusions: Increased plasma nitrite/nitrates and increased organ failure scores occurred in the children with sepsis who had an exaggerated proinflammatory state, despite a pronounced anti-inflammatory response. When the anti-inflammatory response predominated and the proinflammatory state was dampened, organ failure status improved.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Interleukin-10 / blood*
  • Interleukin-6 / blood*
  • Male
  • Multiple Organ Failure / metabolism*
  • Nitrates / blood
  • Nitric Oxide / metabolism*
  • Nitrites / blood
  • Prospective Studies
  • Sepsis / blood
  • Sepsis / metabolism*


  • Interleukin-6
  • Nitrates
  • Nitrites
  • Interleukin-10
  • Nitric Oxide