CLINICAL IMMUNOLOGY
The diagnostic value of early cytokine response in patients after major trauma – preliminary report
Submission date: 2017-02-02
Final revision date: 2017-04-25
Acceptance date: 2017-05-04
Publication date: 2018-03-30
Cent Eur J Immunol 2018;43(1):33-41
KEYWORDS
ABSTRACT
This study was aimed to give a better understanding of the mechanisms of early immune response to trauma by assessing the concentration of cytokines in peripheral blood. The study group comprised 32 patients admitted to the Emergency Department due to injury. Depending on the magnitude of the Injury Severity Score (ISS) trauma patients were divided into two groups. In group A (ISS ≥ 20), 13 patients had complications, and five died, while in group B (ISS < 20) only three patients had complications (e.g. respiratory failure and infections). Depending on the extent of the injury, significant differences were observed in the concentrations of cytokines in the treatment groups. The highest levels of IL-6 and IL-1Ra in both groups were recorded in the third hour of hospitalisation and were considerably higher in group A compared to the concentration of these cytokines in group B (p = 0.001). In patients with complications, IL-6 and IL-1Ra concentrations were significantly higher compared to those without complications. Spearman’s rho-correlation showed a statistically significant positive correlation between baseline concentrations of IL-6 (r = 0.64, p < 0.001) and IL-1Ra (r = 0.37,
p = 0.042) and the values of the ISS. A high diagnostic sensitivity calculated from ROC curves was found for IL-6 concentrations. In summary, our findings suggest that elevated levels of the cytokines tested, determined in the peripheral blood shortly after injury, may be significantly associated with the occurrence of severe complications, which in some patients can lead to death. Monitoring the levels of these cytokines in patients with a high risk of serious complications should be used routinely.
p = 0.042) and the values of the ISS. A high diagnostic sensitivity calculated from ROC curves was found for IL-6 concentrations. In summary, our findings suggest that elevated levels of the cytokines tested, determined in the peripheral blood shortly after injury, may be significantly associated with the occurrence of severe complications, which in some patients can lead to death. Monitoring the levels of these cytokines in patients with a high risk of serious complications should be used routinely.
REFERENCES (27)
1.
Peden M, Scurfield R, Sleet D, et al. (2004): World report on road traffic injury prevention. WHO, Geneva.
3.
Wafaisade A, Lefering R, Bouillon B, et al. (2011): Epidemiology and risk factors of sepsis after multiple trauma: an analysis of 29,829 patients from the Trauma Registry of the German Society for Trauma Surgery. Crit Care 39: 621-628.
4.
Binkowska A, Michalak G, Słotwiński R (2015): Current views on the mechanisms of immune responses to trauma and infection. Centr Eur J Immunol 40: 206-216.
6.
Moore FA, Sauala A, Moore EE, et al. (1996): Postinjury Mulitple Organ Failure: A Bimodal Phenomenon. J Trauma 40: 501-512.
7.
Bone RC (1996): Sir Isaac Newton, sepsis, SIRS, and CARS. Crit Care Med 24: 1125-1128.
8.
Tschoeke SK, Ertel W (2007): Immunoparalysis after multiple trauma. Injury 38: 1346-1357.
9.
Namas R, Ghuma A, Hermus L, Zamora R, Okonkwo DO, Billiar TR, Vodovotz Y (2009): The Acute Inflammatory Response in Trauma/Hemorrhage and Traumatic Brain Injury: Current State and Emerging Prospects. Libyan J Med 4: 97-103.
10.
van Griensven M, Krettek C, Pape HC (2003): Immune reaction after trauma. Eur J Trauma 29: 181-192.
11.
Murphy TJ, Paterson HM, Mannick JA, Lederer JA (2004): Injury, sepsis, and regulation of Toll-like receptor responses. J Leukoc Biol 75: 400-407.
12.
Xiao W, Mindrinos MN, Seok J, et al. (2011): A genomic storm in critically injured humans. J Exp Med 208: 2581-2590.
13.
Roquilly A, Villadangos JA (2015): The role of dendritic cell alterations in susceptibility to hospital-acquired infections during critical-illness related immunosuppression. Mol Immunol 68 (2PtA): 120-123.
14.
Shelhamer MC, Rowan MP, Cancio LC, et al. (2015): Elevations in inflammatory cytokines are associated with poor outcomes in mechanically ventilated burn patients. J Trauma Acute Care Surg 79: 431-436.
15.
Slotwiński R, Olszewski WL, Chaber A, et al. (2002): The soluble tumor necrosis factor receptor I is an early predictor of local infective complications after colorectal surgery. J Clin Immunol 22: 289-296.
16.
Champion HR, Copes WS, Sacco WJ, et al. (1990): The Major Trauma Outcome Study: establishing national norms for trauma care. J Trauma 30: 1356-1365.
17.
Rowell SE, Barbosa RR, Diggs BS, Schreiber MA (2011): Specific abbreviated injury scale values are responsible for the underestimation of mortality in penetrating trauma patients by the injury severity score. J Trauma 71 (2 Suppl 3): S384-S388.
18.
Leung GK, Chang A, Cheung FC, et al. (2011): The first 5 years since trauma center designation in the Hong Kong Special Administrative Region, People’s Republic of China. J Trauma 70: 1128-1133.
19.
Raymondos K, Martin MU, Schmudlach T, et al. (2012): Early alveolar and systemic mediators relase in patients at different risks for ARDS after mulitple trauma. Injury 43: 189-195.
20.
Hur J, Yang HT, Chun W, et al. (2015): Inflammatory Cytokines and Their Prognostic Ability in Cases of Major Burn Injury. Ann Lab Med 335: 105-110.
21.
Kirchhof C, Biberthaler P, Mutscler WE, Faist E, Jochum M, Zedler S (2009): Early down – regulation of the pro-inflammatory potential of monocytes is correlated to organ dysfunction in patients after severe multiple injury: a cohort study. Critical Care 13: 1-11.
22.
Haller JM, McFadden M, Kubiak EN, et al. (2015): Inflammatory cytokine response following acute tibial plateu fracture. J Bone Joint Surg Am 97: 478-483.
23.
Strecker W, Gebhard F, Rager J, et al. (2002): Interleukin-6 (IL-6) – an Early Marker of Chest Trauma. Eur J Trauma 28: 75-84.
24.
Brøchner AC, Toft P (2009): Pathophysiology of the systemic inflammatory response after major accidental trauma. Scand J Trauma Resusc Emerg Med 17: 43.
25.
Reikeras O, Borgen P, Reseland JE, et al. (2014): Changes in serum cytokines in response to musculoskeletal surgical trauma. BMC Research Notes 7: 128.
26.
Schlosser HG, Volk HD, Splettstösser G, Brock M, Woiciechowsky C (2007): A New Qualitive Inerleukin+6 Bedside Test Can Predict Pneumonia in Patients With Severe Head Injury-Comparison to the Standard Immulite Test and Semiquantitative Bedside Test. J Neurosurg Anesthesiol 19: 5-9.
27.
Chaemsaithong P, Romero R, Korzeniewski SJ, et al. (2015): A rapid interleukin-6 bedside test for the identification of intra-amniotic inflammation in pretern labor with intact membranes. J Matern Fetal Neonatal Med 29: 349-359.
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