CLINICAL IMMUNOLOGY
Analysis of selected pro- and anti-inflammatory cytokines in patients with multiple injuries
in the early period after trauma
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Submission date: 2016-06-29
Final revision date: 2016-09-16
Acceptance date: 2016-09-25
Publication date: 2018-03-30
Cent Eur J Immunol 2018;43(1):42-49
KEYWORDS
ABSTRACT
Introduction:
Severe trauma causes damage to the protective barriers of the organism, and thus activates immunological reaction. Among substances secreted during this process pro-inflammatory cytokines are of high importance.
The aim of the study:
Severe trauma causing multiple injuries is more likely to lead to particularly intensive inflammatory reaction, which can sometimes lead to serious complications, even life-threatening. The aim of the study is to determine those parameters which may serve as predictors of infectious complications and to enable estimation of the patient’s immunological status before the decision to introduce elective procedures.
Material and methods:
The study population included patients with multiple trauma treated in the Department of Trauma Surgery of the Medical University of Gdańsk. The severity of injuries was evaluated with commonly used numerical scales (Revised Trauma Score – RTS, Injury Severity Score – ISS, Glasgow Coma Scale – GCS). Blood samples were collected on the first, second, and fifth day after injury. Evaluated parameters: C-reactive protein (CRP), the level of cytokines: IL-8, IL-1, IL-6, TNF, IL-12p70, and IL-10. Control population: individuals without injury.
Results:
Evaluation of IL-6, IL-8, and CRP levels in patients with multiple trauma in the early period after injury (2-3 days) could be considered as a predictor of delayed infection (5-10 days). CRP level, being cheap and commonly accessible, can be used in clinical practice enabling identification of patients at higher risk of infectious complications and introduction of appropriate treatment and prevention. The analysis of the mentioned parameters may contribute to choosing an appropriate management strategy, including “timing” depending on the patient’s biological status.
REFERENCES (30)
1.
Faist E, Wichmann MW (1997): Immunologie bei Schwerverletzten. Chirurg 68: 1066-1070.
2.
Giannoudis PV (2003): Current concepts of the inflammatory response after major trauma: an update. Injury 34: 397-404.
3.
van Griensven M, Krettek C, Pape HC (2003): Immune Reactions after Trauma. Eur J Trauma 29: 181-192.
4.
Hranjec T, Swenson BR, Dossett LA, et al. (2010): Diagnosis-Dependent Relationships between Cytokine Levels and Survival in Patients Admitted for Surgical Critical Care. J Am Coll Surg 210: 833-844.
5.
Jastrow KM, McGuire MF, Gonzalez EA, et al. (2009): Cytokine profiling: A tool for predicting early MOF in trauma patients. J Am Coll Surg 209: 320-331.
6.
Mimasaka S, Funayama M, Hashiyada M, et al. (2007): Significance of levels of IL-6 and IL-8 after trauma: A study of 11 cytokines post-mortem using multiplex immunoassay. Injury 38: 1047-1051.
7.
Reikerås O (2010): Immune depression in musculoskeletal trauma. Inflamm Res 59: 409-414.
8.
Butcher N, Balogh ZJ (2009): The definition of polytrauma: the need for international consensus. Injury 40 (Suppl 4): S12-S22.
9.
Morley J, Kossygan K, Giannoudis PV (2002): Damage control orthopaedics: a new concept in the management of the multiply injured patient. Current Orthopaedics 16: 362-367.
10.
Tien H, Chub PTY, Brennemanc F (2004): Causes of death following multiple trauma. Current Orthopaedics 18: 304-310.
11.
Seekamp A, van Griensven M, Lehmann U, et al. (2002): Serum IL-6, IL-8 and IL-10 Levels in Multiple Trauma Compared to Traumatic Brain Injury and Combined Trauma. Eur J Trauma 3: 183-189.
12.
Yao Y-M, Redl H, Bahrami S, et al. (1998): The inflammatory basis of trauma/shock-associated multiple organ failure. Inflamm Res 47: 201-210.
13.
Hildebrand F, Frink M, Mommsen P, et al. (2007): Bedeutung des Immunmonitorings in der unfallchirurgischen Intensivmedizin. Trauma Berufskrankh 3: 196-200.
14.
Frank J, Maier M, Koenig J, et al. (2002): Circulating Inflammatory and Metabolic Parameters to Predict Organ Failure after Multiple Trauma: Eur J Trauma 28: 333-339.
15.
Cederberg D, Siesjö P (2010): What has inflammation to do with traumatic brain injury? Childs Nerv Syst 26: 221-226.
16.
Walsh DS, Thavichaigarn P, Pattanapanyasat K, et al. (2005): Characterization of circulating monocytes expressing HLA-DR or CD71 and related soluble factors for 2 weeks after severe, non-thermal injury. J Surg Res 129: 221-230.
17.
Wright EH, Khan U (2009): Serum complement-reactive protein (CRP) trends following local and free-tissue reconstructions for traumatic injuries or chronic wounds of the lower limb. J Plast Reconstr Aesthet Surg 63: 1519-1522.
18.
Brunengraber LN, Robinson AV, Chwals WJ (2009): Relationship of serum C-reactive protein and blood glucose levels with injury severity and patient morbidity in a pediatric trauma population. J Pediatr Surg 44: 992-996.
19.
Sedlár M, Kudrnová Z, Erhart D, et al. (2010): Older age and type of surgery predict the early inflammatory response to hip trauma mediated by interleukin-6 (IL-6). Arch Gerontol Geriatr 51: e1-6.
20.
Perl M, Huber-Lang M, Gebhard F (2012): The influence of coagulation and inflammation research on the improvement of polytrauma care. Eur J Trauma Emerg Surg 38: 231-239.
21.
Bauer C, Ketter R, Silomon M (2008): Einfluss moderner Laborparameter auf das klinische Management des polytraumatisierten Patienten. Intensivmed 2: 64-69.
22.
Hildebrand F, Frink M, Mommsen P, et al. (2007): Bedeutung des Immunmonitorings in der unfallchirurgischen Intensivmedizin. Trauma Berufskrankh 9: 196-200.
23.
Maier M, Geiger EV, Wutzel S, et al. (2009): Role of Lung Contusions on Posttraumatic Inflammatory Response and Organ Dysfunction in Traumatized Patients. Eur J Trauma Emerg Surg 35: 463-469.
24.
Brand A (2002): Immunological aspects of blood transfusions. Transpl Immunol 10: 183-190.
25.
Matinlauri I (2004): Immunological aspects of blood transfusion preparations. Duodecim 120: 867-875.
26.
Flohé S, Kobbe P, Nast-Kolb D (2007): Immunological reactions secondary to blood transfusion. Injury 38: 1405-1408.
27.
Lannan KL, Sahler J, Spinelli SL, et al. (2013): Transfusion immunomodulation – the case for leukoreduced and (perhaps) washed transfusions. Blood Cells Mol Dis 50: 61-68.
28.
Sido B, Teklote JR, Hartel M, et al. (2004): Inflammatory response after abdominal surgery. Best Pract Res Clin Anaesthesiol 18: 439-454.
29.
Dunker MS, Ten Hove T, Bemelman WA, et al. (2003): Interleukin-6, C-reactive protein, and expression of human leukocyte antigen-DR on peripheral blood mononuclear cells in patients after laparoscopic vs. conventional bowel resection: a randomized study. Dis Colon Rectum 46: 1238-1244.
30.
Maier B, Lefering R, Lehnert M, et al. (2007): Early versus late onset of multiple organ failure is associated with differing patterns of plasma cytokine biomarker expression and outcome after severe trauma. Shock 28: 668-674.