In order to explore whether an organ-specific pattern in cytokine and
lactate concentrations exists in patients with multiple organ failure
(MOF), we measured the cytokines interleukin-1 beta (IL-1 beta), IL-6,
and tumor necrosis factor-alpha (TNF-alpha), and lactate in blood taken
from the hepatic vein, pulmonary capillaries, and peripheral veins of 10
patients with MOF with hepatic involvement (MOF-HI), eight patients with
MOF and adult respiratory distress syndrome (MOF-ARDS), and five
head-injured patients (controls). Ten additional patients participated
in a study of arteriovenous pulmonary concentration gradients of these
substances. For statsitical analysis, nonparametric tests and analysis
of variance (ANOVA) were used. The regional concentrations of these
substances exhibited a different pattern in the two MOF groups. in the
MOF-HI group, mean rt SD cytokines IL-1 beta and IL-6 (pg/ml) were
respectively 216 +/- 100 and 461 +/- 343 in the hepatic sinusoidal
blood; 149 +/- 52 and 293 +/- 204 in pulmonary capillary blood; and 148
+/- 105 and 234 +/- 162 in peripheral venous blood. In the MOF-ARDS
group the corresponding levels were 180 +/- 103 and 235 +/- 124; 235 +/-
94 and 280 +/- 108; and 130 +/- 77 and 194 +/- 127. The TNF-alpha levels
also exhibited the same pattern. The mean +/- SD corresponding levels
(mmol/L) for lactate in the MOF-HI group were 3.1 +/- 1.8, 1.5 +/- 0.3,
and 1.2 +/- 0.6, and in the MOF-ARDS group were 1.1 +/- 0.9, 1.8 +/-
1.1, and 1.0 +/- 0.2, respectively. The differences in the levels of all
substances between the liver and lungs in the two MOF groups were
statistically significant (p < 0.003). In the study of transpulmonary
gradients it was shown that the levels of cytokine and lactate were
lower in arterial blood than in mixed venous blood in MOF-HI patients,
whereas the opposite was true in MOF-ARDS patients. In this study, we
found that in MOF, cytokines and lactate are secreted from the most
severely affected organs
