Serum IL-6, IL-8 and IL-10 Levels in Multiple Trauma Compared to Traumatic Brain Injury and Combined Trauma

Abstract

Background: In recent studies, the role of cytokines in traumatic brain injury (TBI) has been identified and the intrathecal origin of cytokines demonstrated. The question, however, whether or not there is any difference in serum cytokines between TBI, multiple trauma (MT) and the combination of both (MT with TBI) which may significantly contribute to the final outcome, has not been fully examined yet. Patients and Methods: In a prospective study three different groups of trauma patients were monitored for serum cytokine levels over a 7-day period, multiple organ dysfunction (MOD) and final outcome. The patients eligible for this study must have sustained either an isolated traumatic brain injury (TBI), or multiple trauma (MT) without TBI, or a multiple trauma in combination with TBI (MT+TBI). Results: In patients with isolated TBI (n = 40, cranial Abbreviated Injury Score [AIS head ] = 4.4 ± 0.8, total Injury Severity Score [ISS] = 17.1 ± 5.1), serum interleukin-(IL-)6 levels ranged between 150 and 200 pg/ml within the first 48 h followed by a constant decline (< 100 pg/ml) over the 7-day study period. By contrast, serum IL-6 levels of multiply injured patients (n = 10, AIS head = 1.0 ± 1.2, total ISS = 29.9 ± 5.2) were significantly (p < 0.05) increased (range 350-400 pg/ml) after trauma, also followed by a constant decline. In patients suffering from MT including TBI (n = 44, AIS head = 4.1 ± 0.9, total ISS = 31.8 ± 5.8), serum IL-6 levels were also significantly (p < 0.05) higher after trauma compared to TBI patients, but not significantly different from MT patients without TBI. IL-8 and IL-10 serum levels demonstrated a similar pattern, with low cytokine serum levels in the TBI group but significantly high serum levels in both MT groups. The multiple organ dysfunction (MOD) score of Marshall et al revealed no significant change in the TBI group over the 7-day period. In MT patients the MOD score deteriorated transiently around day 3, whereas in the combined trauma group the MOD score was elevated over the entire study period compared to both other trauma groups. Mortality was 27.5% in TBI patients, 0 in MT, and 52.3% in combined trauma. Conclusion: TBI alone does not result in a significant systemic inflammatory response, whereas the combination of TBI and MT seems to enhance the inflammatory reaction ending in a higher MOD incidence and MOD-related mortality as compared to MT without TBI.

Plasma Levels of Procalcitonin and Neopterin in Multiple Trauma Patients with or without Brain Injury

“…In a previous analysis of other mediators, we also failed to detect any specific effect of neurotrauma on TNF receptors, IL-6, IL-10, and PMN elastase (Hensler et al, , 2002. These findings contradicted preliminary data from other groups (Seekamp et al, 2002). NT is thought to induce apoptosis, but little is known on its cellular sources.…”

Effect of Traumatic Brain Injury, Erythropoietin, and Anakinra on Hepatic Metabolizing Enzymes and Transporters in an Experimental Rat Model

“…In contrast, in patients with TBI plus multiple injuries, serum concentrations exceeded CSF concentrations. Seekeamp et al (40) also found that IL-6, IL-8, and IL-10 serum concentrations were significantly higher in patients with multiple injuries compared to TBI alone when measured out to 7 days post-injury. IL-6 was increased to~150 pg/mL in days 1 and 2 in the isolated TBI patients and only stayed elevated in patients with multiple injuries, with an average IL-6 concentration of 350 pg/mL.…”

The prognostic importance of serum IL-1β, IL-6, IL-8 and TNF-α levels compared to trauma scoring systems for early mortality in children with blunt trauma

“…Partrick et al [24] previously measured IL-6 and IL-8 in severely injured patients and found that elevated levels of these proinflammatory cytokines discriminate patients who ultimately develop postinjury multiple organ failure. In patients who had sustained a multiple trauma without any brain injury, the well-documented posttraumatic inflammatory response was noted, as reflected by increased cytokine serum levels (IL-6, IL-8) within the first 48 h after trauma [25]. Strecker et al [26] demonstrated that IL-6, CK and, possibly, IL-8, may help to fill up the diagnostic gap we face in trying to estimate chest and soft tissue trauma in the early posttrauma state.…”

“…[25), IL-8 (B25 or[25), TNF-a (B10,10-20 or [20), ISS, and PTS. Some prognostic factors such as age, IL-1b, IL-6, PTS were not significantly correlated with mortality, whereas some other risk factors such as IL-8 (P = 0.004), [20 TNF-a (P = 0.04), and ISS (P = 0.007) were significant in their relationship to mortality.…”