ABSTRACT
Structural cells as well as immune effector cells of the lung are capable of cytokine production and release. Some of cytokines receiving the most attention to date in relation to pulmonary diseases include [TNF-alpha] and [IL-6], but there are no available reports with respect to the role of soluble tumor necrosis factor receptor-I [sTNFR-I] and soluble interlukin-6 receptor [sIL-6R] in lung diseases especially acute respiratory failure [ARF]. This work was done to assess the role of serum levels of sTNFR I and sIL-6R in critically ill children with acute respiratory failure [ARF] in ICU. The study included 18 patients [11 males and 7 females, aged 3 days-14 years] classified into 8 patients with mild [ARF], 8 patients with moderate [ARF] and 2 patients with severe [ARF]; in addition to, 13 healthy subjects of matched age and sex as controls. They were subjected to thorough history and clinical evaluation, CBC, CRP, ESR, blood gases, pulmonary function test, assessment of Pediatric Index of Mortality [PIM score] and cytokine assay serum [sTNFR-I and sIL-6R] by ELISA technique, Statistical analysis of our results revealed the following: [1] Highly significant increase in serum levels of sTNFR-I [p<0.0001], but insignificant increase in serum levels of sIL-6R [p<0.0001], in acute respiratory failure patients compared to controls; [2] Significant positive correlation between serum levels of sTNFR-I and severity of acute respiratory failure [r = 0.56, p = 0.02] and PIM system [r = 0.49, p = 0.04] While; insignificant correlation between serum levels of sIL-6R and severity of acute respiratory failure [r = 0.04, p = 0.88] and PIM system [r = 0.01, p = 0.96] sTNFR-I may be involved in the pathogenesis of acute respiratory failure. sTNFR may have significant prognostic value in ICU patients with acute respiratory failure since higher serum levels of sTNFR-I may be related to severity and mortality of patients with acute respiratory failure