Hedetoft M, Garred P, Madsen MB, Hyldegaard O, et al.
Physiological reports. Date of publication 2021 Mar 1;volume 9(6):e14757.
1. Physiol Rep. 2021 Mar;9(6):e14757. doi: 10.14814/phy2.14757.
Hyperbaric oxygen treatment is associated with a decrease in cytokine levels in
patients with necrotizing soft-tissue infection.
Hedetoft M(1), Garred P(2), Madsen MB(3), Hyldegaard O(1).
Author information:
(1)Department of Anaesthesia, Hyperbaric Unit, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark.
(2)Laboratory of Molecular Medicine, Department of Clinical Immunology Section
7631, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
(3)Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital,
Copenhagen, Denmark.
BACKGROUND: The pathophysiological understanding of the inflammatory response in
necrotizing soft-tissue infection (NSTI) and its impact on clinical progression
and outcomes are not resolved. Hyperbaric oxygen (HBO2 ) treatment serves as an
adjunctive treatment; however, its immunomodulatory effects in the treatment of
NSTI remains unknown. Accordingly, we evaluated fluctuations in inflammatory
markers during courses of HBO2 treatment and assessed the overall inflammatory
response during the first 3 days after admission.
METHODS: In 242 patients with NSTI, we measured plasma TNF-α, IL-1β, IL-6,
IL-10, and granulocyte colony-stimulating factor (G-CSF) upon admission and
daily for three days, and before/after HBO2 in the 209 patients recieving HBO2 .
We assessed the severity of disease by Simplified Acute Physiology Score (SAPS)
II, SOFA score, and blood lactate.
RESULTS: In paired analyses, HBO2 treatment was associated with a decrease in
IL-6 in patients with Group A-Streptococcus NSTI (first HBO2 treatment, median
difference -29.5 pg/ml; second HBO2 treatment, median difference -7.6 pg/ml),
and overall a decrease in G-CSF (first HBO2 treatment, median difference
-22.5 pg/ml; 2- HBO2 treatment, median difference -20.4 pg/ml). Patients
presenting with shock had significantly higher baseline cytokines values
compared to non-shock patients (TNF-α: 51.9 vs. 23.6, IL-1β: 1.39 vs 0.61, IL-6:
542.9 vs. 57.5, IL-10: 21.7 vs. 3.3 and G-CSF: 246.3 vs. 11.8 pg/ml; all
p < 0.001). Longitudinal analyses demonstrated higher concentrations in septic
shock patients and those receiving renal-replacement therapy. All cytokines were
significantly correlated to SAPS II, SOFA score, and blood lactate. In adjusted
analysis, high baseline G-CSF was associated with 30-day mortality (OR 2.83, 95%
CI: 1.01-8.00, p = 0.047).
CONCLUSION: In patients with NSTI, HBO2 treatment may induce immunomodulatory
effects by decreasing plasma G-CSF and IL-6. High levels of inflammatory markers
were associated with disease severity, whereas high baseline G-CSF was
associated with increased 30-day mortality.
© 2021 The Authors. Physiological Reports published by Wiley Periodicals LLC on
behalf of The Physiological Society and the American Physiological Society.
DOI: 10.14814/phy2.14757
PMCID: PMC7957267
PMID: 33719215 [Indexed for MEDLINE]
Conflict of interest statement: No conflicts of interests, financial, or
otherwise declared by the authors.
