Interleukin-6 as inflammatory marker referring to multiple organ dysfunction syndrome in severely injured children

Andruszkow, Hagen; Fischer, J; Sasse, Michael; Brunnemer, Ulf; Andruszkow, Julia; Gänsslen, Axel; Hildebrand, Frank; Frink, Michael

doi:10.1186/1757-7241-22-16

Cited by 23 publications

(27 citation statements)

References 38 publications

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“…IL-6 is a prognostic marker for trauma outcome and development of multiple organ failure. Increased posttraumatic IL-6 levels have been associated with unfavorable outcome [ 20 , 21 ]. In this regard, Pape et al indicated that IL-6 levels >800 pg/ml were associated with increased organ failure in multiple injured patients [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

The immune response after fracture trauma is different in old compared to young patients

et al. 2014

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BackgroundDespite significant medical progress and improved treatment, surgical procedures of proximal femur fractures in older patients are still associated with a high postoperative complication and mortality rate. Recently, several authors investigated the phenomenon of immunoageing, indicating differences in the ageing immune system.The aim of the present multi-center prospective clinical trial was to analyze differences in the posttraumatic immune response of old patients compared to young patients.MethodsBlood was collected from young patients (<50 y, n = 20) with long bone fractures (YF), old patients (>70 y, n = 21) with proximal femur fractures (OF) upon clinical admission and within 6 hours after surgery, and two healthy age matched control groups (YH & OH). Serum TRAIL- and cytokine concentrations were analyzed via cytometric bead array, Fas-Ligand and TNF-Receptor-I via ELISA. CD15+ magnetic bead-isolated neutrophils (PMN) were TUNEL stained.ResultsIL-6 was significantly increased only in OF after trauma and surgery whereas YF patient exhibited a marked decrease of TNF after trauma. Interestingly, a significant increase of GM-CSF serum levels was observed in YF only, whereas OF exhibited a decrease of systemic IFN-γ concentrations after trauma and after surgery. The healthy controls, old and young, had more or less similar inflammation levels.Moreover, TRAIL serum levels were diminished in OF after trauma and even further after surgery whereas in YF this was only observed after the surgical procedure. Fas-L concentrations were reduced only in YF after surgery or trauma. PMN apoptosis was significantly reduced only in YF, indicating activation of the innate immune system.DiscussionIn summary, our data suggest that the posttraumatic immune response is differently regulated in old and young trauma patients. The operative procedure further impacts these differences after trauma. Whether the decreased activation of PMNs and phagocytes along with the observed dysregulation of the posttraumatic inflammatory response contributes to the high perioperative mortality rate of the elderly suffering from a proximal femoral fracture requires further investigation.

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Section: Discussionmentioning

confidence: 99%

The immune response after fracture trauma is different in old compared to young patients

et al. 2014

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“…From a clinical point of view, the critically ill polytrauma patient is characterized by a series of primary traumatic injuries, as well as by a multitude of trauma-associated secondary injuries such as hemorrhagic shock, tissue hypoxia, generalized inflammation, oxidative stress, and infections. All of these subsequently lead to a multiple organ dysfunction syndrome (MODS) and to a significant increase in mortality rates [7,[31][32][33][34].…”

Section: Molecular and Pathophysiological Aspects Of Metabolismmentioning

confidence: 99%

Assessment of Metabolic and Nutritional Imbalance in Mechanically Ventilated Multiple Trauma Patients: From Molecular to Clinical Outcomes

et al. 2019

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The critically ill polytrauma patient is characterized by a series of metabolic changes induced by inflammation, oxidative stress, sepsis, and primary trauma, as well as associated secondary injuries associated. Metabolic and nutritional dysfunction in the critically ill patient is a complex series of imbalances of biochemical and genetic pathways, as well as the interconnection between them. Therefore, the equation changes in comparison to other critical patients or to healthy individuals, in which cases, mathematical equations can be successfully used to predict the energy requirements. Recent studies have shown that indirect calorimetry is one of the most accurate methods for determining the energy requirements in intubated and mechanically ventilated patients. Current research is oriented towards an individualized therapy depending on the energy consumption (kcal/day) of each patient that also takes into account the clinical dynamics. By using indirect calorimetry, one can measure, in real time, both oxygen consumption and carbon dioxide production. Energy requirements (kcal/day) and the respiratory quotient (RQ) can be determined in real time by integrating these dynamic parameters into electronic algorithms. In this manner, nutritional therapy becomes personalized and caters to the patients’ individual needs, helping patients receive the energy substrates they need at each clinically specific time of treatment.

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“…Pediatric major trauma patients are also at risk for MODS; data suggest that MODS occurs in as many as 12% of children admitted to a pediatric intensive care unit with an injury severity score greater than nine (56). Much of that morbidity would appear to be associated with traumatic brain injury as the incidence of MODS in pediatric trauma patients decreases substantially when TBI patients are excluded from analysis (57).…”

Section: Traumamentioning

confidence: 99%

“…The pathogenesis of MODS associated with pediatric trauma is just beginning to be elucidated, but would appear to emanate from a variety of potential causes including inflammation, immune dysfunction, endothelial injury, secondary infection and hemorrhage. Data suggest that IL-6 levels are elevated in critically injured children with some data suggesting an association between these levels and the occurrence of MODS (56, 58). Additionally, immune paralysis has also been reported in critically injured pediatric trauma patients using ex vivo lipopolysaccharide-induced tumor necrosis factor alpha production capacity assessments (58).…”

Section: Traumamentioning

confidence: 99%

Specific Etiologies Associated With the Multiple Organ Dysfunction Syndrome in Children: Part 2

Upperman

Bucuvalas

Williams

et al. 2017

Pediatric Critical Care Medicine

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Objective To describe a number of conditions and therapies associated with multiple organ dysfunction syndrome (MODS) presented as part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development MODS Workshop (March 26–27, 2015). In addition, the relationship between burn injuries and MODS is also included although it was not discussed at the Workshop. Data Sources Literature review, research data, and expert opinion. Study Selection Not applicable. Data Extraction Moderated by an expert from the field, issues relevant to the association of MODS with a variety of conditions and therapies were presented, discussed and debated with a focus on identifying knowledge gaps and research priorities. Data Synthesis Summary of presentations and discussion supported and supplemented by relevant literature. Conclusions Sepsis and trauma are the two conditions most commonly associated with MODS both in children and adults. However, many other pathophysiologic processes may result in MODS. In this paper, we discuss conditions such as liver failure and pancreatitis, pathophysiologic processes such as ischemia and hypoxia, and injuries such as trauma and burns. Additionally, therapeutic interventions such as medications, blood transfusions, transplantation may also precipitate and contribute to MODS. The purpose of this manuscript is to describe the association of MODS with a variety of conditions and therapies in an attempt to identify similarities, differences and opportunities for therapeutic intervention.

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Interleukin-6 as inflammatory marker referring to multiple organ dysfunction syndrome in severely injured children

Cited by 23 publications

References 38 publications

The immune response after fracture trauma is different in old compared to young patients

The immune response after fracture trauma is different in old compared to young patients

Assessment of Metabolic and Nutritional Imbalance in Mechanically Ventilated Multiple Trauma Patients: From Molecular to Clinical Outcomes

Specific Etiologies Associated With the Multiple Organ Dysfunction Syndrome in Children: Part 2

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