Intestinal Permeability and Cytokine Inflammatory Response in Multiply Injured Patients

Abstract

In experimental settings, the increased intestinal permeability (IP) following severe trauma is associated with increased serum concentrations of cytokines. Multiply injured patients are susceptible to the development of multiple organ failure (MOF). The aim of this study was to determine if altered IP after trauma was associated with upregulation of cytokines and if cytokines and IP influenced the development of MOF. In 30 multiply injured patients, IP was measured on days 2 and 4 after injury using the lactulose-mannitol (L-M) test, and the levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), and IL-8 were determined simultaneously. The L-M ratio increased significantly from 0.049 (0.017-0.133) on day 2 to 0.150 (0.059-0.339) on day 4 (p < 0.02) On day 4, a significant correlation was also found between the L-M ratio and IL-6 (r = 0.43, p < 0.03). The IL-6 level on days 2 and 4 was significantly (p < 0.01 and p < 0.03, respectively) higher in MOF patients than in those without MOF, as was the TNF-alpha level on day 4 significantly higher (p < 0.04) in MOF patients. IP increases following multiple trauma, and on day 4 it correlates with the IL-6 level. However, in patients who develop MOF only cytokines are invariably increased, with IL-6 alone being significantly increased on both measurements in these patients.

CK/CK-MB ratio as an indirect predictor for survival in polytraumatized patients

“…The demands of acute care research and difficulties in application of research protocols in nocturnal weekend hours are primary factors why acute care resuscitation research has attracted so little effort. The very well-known example of troponin and CK-MB as early markers for detection of myocardial infarction can be seen as an ideal ante type for trauma-related research [33]. Karmen et al published the revolution in acute myocardial infarction diagnosis with elevated activities of enzymes in blood in 1955 [12,32].…”

“…In addition, individual trauma pattern and severity was described by a simple classification HTAPE focusing on the injury in the five body regions head (H), thorax (T), abdomen (A), pelvis (P), and extremities (E) [33]. Abbreviated Injury Score (AIS) was graded for all patients admitted to our ER immediately after arrival.…”

“…The information about the long-term mortality and causes of death after multiple injuries is sparse [33]. Therefore, it is important to study the factors affecting the clinical mortality of the polytraumatized population [35].…”

“…Rooted on those findings, trauma research might shift from "classic scoring systems" to new markers predicting outcome or surveillance [1,33].…”

Intestinal Barrier Function and the Brain-Gut Axis

“…Similarly, gut inflammation and loss of gut barrier function has been related to splachnic ischemia-reperfusion through HIF-1 activation [257]. Multiple injured patients also show an increased intestinal permeability that correlates with IL-6 levels [258]. Severe burn injury also results in the loss of intestinal barrier function involving MLCK-dependent MLC phosphorylation signalling pathway [259] and p38 MAPK activation [260] in a TLR-4-dependent process [261].…”