Measurement of Cytokines and Adhesion Molecules in the First 72 Hours after Severe Trauma: Association with Severity and Outcome

Abstract

Introduction. Severity and outcome assessments are crucial in trauma. Our aim was to describe the role of a group of cytokines (TNFα, IL-6, IL-10, and HMGB-1) and ICAM-1 as severity and outcome assessment tools and their kinetics in the first 72 h after severe trauma. Materials and Methods. Authors designed a prospective cohort study of severe polytrauma patients (ISS > 15) in a level 1 Trauma Centre. Cytokines and ICAM-1 levels and Th1/Th2 ratios were assessed at admission, 24, 48, and 72 h. SIRS, SIRS with hypoperfusion, and shock were identified. Outcomes considered were ICU admission, ARDS, MODS, and death. Results. Ninety-nine patients were enrolled (median ISS: 29 and age 31). There was an early release of pro- and anti-inflammatory mediators with higher values at admission (except for ICAM-1). On admission, IL-6 was associated with ISS, IL-10 with SIRS with hypoperfusion, and HMGB-1 with shock. Several cytokines were associated with outcomes, especially IL-6 and IL-10 at 72 h with MODS and death. Low TNFα/IL-10 and IL-6/IL-10 ratios at 24 and 72 h were associated with MODS and death. Conclusions. Pro- and anti-inflammatory responses occur simultaneously and earlier after injury. Cytokines may be useful for outcome assessment, especially IL-6 and IL-10. Low Th1/Th2 ratio at 24 to 72 h is associated with MODS and death.

Systemic inflammatory profiles and their relationships with demographic, behavioural and clinical features in acute low back pain

“…First, injury severity may explain the results. Proinflammatory cytokine concentrations relate to the degree of tissue injury [44,100]. Although the injury may have been insufficient to stimulate specific cytokines detectably, the cumulative effect of cytokines may underlie detectable CRP production.…”

Predictive value of cytokines for developing complications after polytrauma

“…IL-6: (1) ARDS; two studies [37,45] could not relate ARDS to IL-6 concentration alterations, whereas two other studies [48,51] found a positive correlation (Table 2); (2) Sepsis; five studies [35,41,46,47,53] found an increased IL-6 production to be predictive for the development of sepsis, whereas five other studies [28,29,38,39,55] did not (Table 3); (3) MODS; all five prospective cohort studies [3,28,34,46,51] concluded that IL-6 is markedly increased in the early development of MODS ( Dekker ABE et al . Do cytokines predict polytrauma outcome IL-10: (1) Three studies, two prospective [54,57] and one retrospective [14] , could not relate the serum IL-10 concentrations to the development of ARDS.…”

“…Do cytokines predict polytrauma outcome IL-10: (1) Three studies, two prospective [54,57] and one retrospective [14] , could not relate the serum IL-10 concentrations to the development of ARDS. One study [51] found IL-10 to be significantly higher in patients with ARDS; (2) Of the five reviewed studies, three prospective [29,50,54] and one retrospective study [14] found the IL-10 concentration to be predictive for the development of sepsis, whereas one prospective study [53] did not; (3) Two studies [51,54] reported IL-10 to be significantly elevated in patients with MODS, and two studies [3,57] could not find an association between the cytokine and development of MODS; and (4) According to five studies [13,32,33,36,50] the serum IL-10 concentration was significantly higher in MOF patients. One study showed no significant elevation [27] .…”

“…(1) Three studies found no relation between TNF-a and development of ARDS [37,45,51] ; (2) One study [55] concluded that concentrations were not related to development of sepsis, while one study [50] found significantly increased concentrations in septic patients; (3) Of the four studies reporting on TNF-a concentrations after trauma, two studies [31,51] found TNF-a to be related to the development of MODS, and two studies [3,57] could not relate serum concentrations [35] 2009 P-coh 1032 IL-6 10% 2…”

“…Paunel-Görgülü et al [47] 2011 P-coh 47 (17) IL-6 38% 11% 34 Raymondos et al [48] 2012 P-coh 24 IL-6, -8, -1β, TNF- 29% 4% 35 Roetman et al [60] 2008 P-cc 229 (110) IL-18, -4; IFN-γ 16% 36 Schinkel et al [61] 2005 P-cc 216 (110) IL-11 4% 16% 37 Sherry et al [14] 1996 R-cc 66 (10) IL-10 8% 39% 2% 38 Sousa et al [51] 2015 P-coh 99 IL-6, -10; TNF- 19% 34% 28% 38 Spielmann et al [57] 2001 P-cc 47 (15) TNF- 11% 30% 51% 23% 39 Svoboda et al [62] 1994 P-cc 42 (12) IL-1β, -2, -6; TNF- 33% 26% 40 Wick et al [49] 2000 P-coh 37 IL-12 11% 16% 41 Yagmur et al [63] 2005 P-cc 99 (10) IL-1, -2, -6, -8; TNF- 17% Table 1 Overview of included studies, the studied cytokines and the outcome parameters (acute respiratory distress syndrome, sepsis, muli-organ dysfunction syndrome, multi-organ failure, mortality)…”