Are serum cytokines sensitive and specific enough to prognosticate in aspergillosis?

摘要

Chai et al [1] are to be commended for their admirable effort to find associations between some (IL-6, IL-8, IL-10, INF-8, and C-reactive protein) but not all serum cytokines and the clinical response (at 12 weeks) and outcome (mortality at day 84) in patients with invasive aspergillosis (IA). Because no I A-attributable mortality was analyzed, the similarity in cytokine profiles with nonresponders and nonsurvivors is reassuring; several competing causes of death exist in severely immunosup-pressed hosts who develop IA.However, these interesting data do not address the issue of whether serum cytokine level changes are inherently linked to the natural history of IA (progression or not) per se and not to the underlying disease. As up to 74% of patients in the cohort analyzed had he-matologic malignancy, and because information about remission rates and neutropenia status (eg, recovery or not in cytopenic patients) in responders or not is not provided, a question arises: are these cytokine changes merely a sophisticated marker to describe the evolution of underlying hematologic disease? For example, Kornblau et al [2] recently described that there are specific serum cytokine signatures (including IL-8) that impact leukemia-related survival, independent of infections.