The clinical significance of serum and urine cytokines in patients with acute uncomplicated pyelonephritis

초록

Purpose: In this prospective study, we evaluated the clinical significance of inflammatory cytokines in women with acute uncomplicated pyelonephritis undergoing antimicrobial therapy. Materials and Methods: We analyzed 26 female patients diagnosed with acute uncomplicated pyelonephritis between September 2007 and March 2008. Body temperature, white blood cell (WBC) counts, serum C-reactive protein (CRP), and serum and urine interleukin (IL)-6 and IL-8 were measured before and 12 hours, 24 hours, and 4 days after the intravenous administration of empirical ciprofloxacin. Results: Initial serum CRP levels were correlated with initial serum IL-6 and initial urine IL-8 levels. Twenty-four hours after the start of antibiotic treatment, the CRP level and urine IL-8 level continued to be high, whereas serum IL-6 levels decreased significantly (26.1±32.4 vs 9.9±23.5pg/dl, p < 0.01). When we divided the patients into mild (CRP< 15mg/dl, n=14) and severe (CRP->15mg/ dl, n=12) groups according to initial CRP levels, the serum IL-6 level decreased significantly in both the mild (14.2±4.0 vs 4.0±1.7pg/dl, p<0.01) and the severe (41.1±12.7 vs. 22.7±16.4pg/dl, p<0.01) groups within 24 hours, whereas CRP and urine IL-8 levels did not change significantly in either group. Conclusions: Clinically, initial serum IL-6 and urine IL-8 levels were increased according to disease severity. Moreover, the serum IL-6 level decreased rapidly after antibiotic treatment within 24 hours. Serum IL-6 levels are a better indicator of the severity of disease and the therapeutic effect of empirical parenteral antibiotic use in patients with acute uncomplicated pyelonephritis than were either CRP or WBC counts.

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