• The level of tumor necrosis factorα (TNFα), a monokine implicated in mediating septic shock, is elevated in the blood of some patients with sepsis. Monocytes from 11 trauma patients and 11 burn patients were suboptimally stimulated with interferon gamma and muramyl dipeptide, an analogue of bacterial wall products. The patients with sepsis showed significantly greater total TNFα levels (secreted in combination with cell-associated) 3 days before septic episodes, as compared with normal controls (32.38 to 2231.76 ng/106 monocytes per milliliter, median = 121.03 ng/106 monocytes per milliliter; normal control: 0.00 to 18.20 ng/106 monocytes per milliliter, median = 5.93 ng/106 monocytes per milliliter). Increases in patients' total monocyte TNFα levels greater than 30 ng/106 monocytes per milliliter correlated with septic episodes. In patients with sepsis, the total monocyte TNFlevels were increased despite a concomitant increase in their prostaglandin E2 levels in both stimulated (interferon gamma plus muramyl dipeptide) and unstimulated in vitro assays (9 patients: stimulated prostaglandin E2 range, 30.1 to 123.6 ng/106 monocytes per milliliter). Massively elevated monocyte TNFα and prostaglandin E2 production occurred simultaneously in patients with sepsis.
(Arch Surg. 1990;125:29-35)