Prognostic predictive values of serum cytochrome c, cytokines, and other laboratory measurements in acute encephalopathy with multiple organ failure

Mitsuaki Hosoya ^1*, Yukihiko Kawasaki ¹, Masahiko Katayose ¹, Hiroko Sakuma ¹, Masakatsu Watanabe ¹, Etsuo Igarashi ¹, Muneo Aoyama ², Hiroyuki Nunoi ³ and Hitoshi Suzuki ¹

¹ Department of Pediatrics, Fukushima Medical University School of Medicine, Japan
² Eizai Co., Ltd, Japan
³ Department of Pediatrics, Miyazaki Medical College, University of Miyazaki, Japan

^* To whom correspondence should be addressed. E-mail: mhosoya{at}fmu.ac.jp.

Accepted 14 December 2005

Abstract

Objective: To evaluate the prognostic predictive values of cytochrome c, cytokines, and other laboratory measurements in serum collected during neurologic onset in acute encephalopathy with multiple organ failure.

Methods: In addition to general laboratory examinations, we measured the concentrations of cytochrome c (apoptosis marker) and cytokines (inflammatory markers) in serum samples collected at the initial phase in 29 patients with acute encephalopathy. The obtained values were evaluated as predictors for the development of severe encephalopathy.

Results: Cytochrome c, tumor necrosis factor (TNF)-, interleukin (IL)-6, soluble TNF-receptor 1 (sTNF-R1), and aspartate aminotransferase (AST) concentrations at the initial phase were high and correlated well with patient outcome. High concentrations of serum cytochrome c (>45 ng/ml), sTNF- R1 (>2000 pg/ml), AST (>58 IU/dl), IL-6 (>60 pg/ml), and TNF- (>15 pg/ml) predicted an unfavorable prognosis (i.e., sequelae and death) at 93%, 79%, 82%, 77%, and 60%, respectively. The specificity of those markers was 100%, 89%, 83%, 100%, and 100%, respectively.

Conclusions: Serum cytochrome c is the most sensitive and specific predictor for the development of severe encephalopathy at the initial phase. Our results suggest that this marker might be used to guide decisions regarding the start of the initial treatment and further intensive care.

Keywords: acute encephalopathy, cytochrome c, cytokine, multiple organ failure, prognostic predictive marker

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