Value of interleukin-18 changes in early warning of organ dysfunction after trauma
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Objective To detect the changes of interleukin-18 (IL-18) in plasma of trauma patients and evaluate their value in early warning of organ dysfunction. Methods A prospective study was carried out in 54 trauma patients admitted in from March 2001 to September 2002, which were divided into low injury severity score(ISS) group (Group L-ISS) and high ISS group (Group H-ISS). ELISA was applied to measure the level of IL-18 of blood samples that were collected on arrival, at days 4, 7 and 14 following admission. In the meantime, IL-18 level of plasma samples from patients with systemic inflammatory response syndrome (SIRS), sepsis and multiorgan dysfunction syndrome (MODS) was retrospectively analyzed so as to calculate the critical value of IL-18 in predicting organ dysfunction. Results After trauma, IL-18 concentration of plasma reached peak at days 4 and 7, and decreased gradually at day 14, which was significantly related to SIRS, sepsis and MODS, respectively. The IL-18 level was high relatively in plasma from patients with organ dysfunction. The higher IL-18 level in plasma within seven days after trauma indicated the severer organ dysfunction. Conclusion IL-18 is sensitive in early warning of organ dysfunction after trauma.Keywords:
Organ dysfunction
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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.
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Excessive proinflammatory activation after trauma plays a role in late morbidity and mortality, including the development of multiple organ dysfunction syndrome (MODS). To date, identification of patients at risk has been challenging. Results from animal and human studies suggest that circulating interleukin 6 (IL-6) may serve as a biomarker for excessive inflammation. The purpose of this analysis was to determine the association of IL-6 with outcome in a multicenter developmental cohort and in a single-center validation cohort. Severely injured patients with shock caused by hemorrhage were evaluated within a multicenter developmental cohort (n = 79). All had blood drawn within 12 h of injury. Plasma IL-6 was determined by multiplex proteomic analysis. Clinical and outcome data were prospectively obtained. Within this developmental cohort, a plasma IL-6 level was determined for the subsequent development of MODS by developing a receiver operating curve and defining the optimal IL-6 level using the Youden Index. This IL-6 level was then evaluated within a separate validation cohort (n = 56). A receiver operating curve was generated for IL-6 and MODS development, with an IL-6 level of 350 pg/mL having the highest sensitivity and specificity within the developmental cohort. IL-6 was associated with MODS after adjusting for Acute Physiology and Chronic Health Evaluation, Injury Severity Score, male sex, and blood transfusions with an odds ratio of 3.9 (95% confidence interval, 1.33 - 11.19). An IL-6 level greater than 350 pg/mL within the validation cohort was associated with an increase in MODS score, MODS development, ventilator days, intensive care unit length of stay, and hospital length of stay. However, this IL-6 level was not associated with either the development of nosocomial infection or mortality. Elevation in plasma IL-6 seems to correlate with a poor prognosis. This measurement may be useful as a biomarker for prognosis and serve to identify patients at higher risk of adverse outcome that would benefit from novel therapeutic interventions.
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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.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.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.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.
Polytrauma
Proinflammatory cytokine
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Objective To investigate the clinical significance of blocking effects of Xuebijing injection on systemic inflammatory response syndrome(SIRS) and multiple organ dysfunction syndrome(MODS) of severe acute disease patients. Methods 120 severe acute disease patients were randomly divided into two groups: control group(n=60) and Xuebijing treatment group(n=60).At 1,3,7,10 days after admission,the contents of TNF-α,IL-1β,IL-6,blood routine,liver and renal function,APACHE Ⅱscore,hospital stay in ICU,mortality rate and the number of MODS cases were observed. Results The expression of serum TNF-α,IL-1β,IL-6 in treatment group were significantly lower than that of control group at 3,7,10d after admission(P0.05 or P0.01).Compared with control group,expression of CRP decreased at 3,7d(P0.01).There were significantly improved of WBC,BPC,ALB,Tbil,Cr and ALT in treatment group compared with control group at 3,7,10d after admission(P0.05 or P0.01).The occurrence rates of organ failure,hospital stay in ICU,mortality rate and APACHEⅡ score at 7,10d were lower than control group(P0.05). Conclusion Xuebijing injection can inhibit the plasma endotoxin,significantly block the development of SIRS and MODS formed,down-regulate TNF-α,IL-1β and IL-6 and protect vital organ dysfunction,improve microcirculation and tissue perfusion and protect the function of important organs.
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To investigate the impact of age and gender on multiple organ dysfunction syndrome (MODS) after multiple injuries and the possible mechanism.The clinical data of 78 patients with multiple injuries admitted in the ICU in our hospital from Jan. 2004 to Jan. 2007 were reviewed for age, gender, ISS, incidence of MODS, sepsis and mortality, days in ICU, and duration of ventilation. The plasma levels of TNF-alpha and IL-6 were examined by ELISA in the first two weeks after the injury, and the results were analyzed in relation to the demographic and clinical data.With similar ISS scores, the male patients were more likely to develop into MODS than the female patients (P<0.05), and age produced a marginal effect on the incidence of MODS (P=0.06). Compared with patients without MODS, those with MODS had a significantly different pattern of plasma TNF-alpha and IL-6 alterations. In the initial week following the injury, the male patients showed significantly higher plasma IL-6 levels than the female patients with the same ISS scores (P=0.04), but the level alteration in the initial two weeks showed no significant difference between the male and female patients (P=0.14).Gender plays an important role in the occurrence of MODS following multiple injuries, but the effect of age on MODS seems only marginal and need to be further investigated.
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Objective: To study the predictive power of systemic inflammatory response syndrome (SIRS) scores, platelet count, and blood glucose level for multiple organ dysfunction syndrome (MODS) in patients with major trauma. Methods: The sample was 87 patients with major trauma, hospitalized within 24 hours after injury. SIRS score, platelet count and maximum blood glucose level were measured within the first 24 hours after injury, while MODS was measured by the Denver post-injury multiple organ failure (MOF) score at the 3rd day after injury. Multiple regression analysis, using the enter method, was employed to analyze the data with a significance level of .05. Results: The majority of the samples were male (85.1%) with an average age of 40.39 years. Most of them sustained multiple organ injuries and received surgical treatment within the first 24 hours. It was found that 25.3% of these patients developed organ dysfunction on the 3rd day after injury while 9.2% experienced MODS. SIRS score, platelet count and blood glucose level could predict MODS in patients with major trauma, with 41.7% of the variance explained (R2 = .417, p < .001). Conclusion: Patients with major trauma should receive close monitoring on their SIRS score, platelet count and blood glucose level within 24 hours after injury. Moreover, Denver post-injury MOF score should be routinely used for detection of organ dysfunction so that preventative measures can be appropriately implemented.
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Background There is still no information on the dynamics of pro- and anti-inflammatory cytokines and mark-ers of the septic process before the clinical manifestation of sepsis. The aim of the study was to analyze the dynamics of inflammation and sepsis markers concentration in early periods in patients with urgent pathology, depending on the subsequently developed sepsis. Materials and methods. The concentration of procalcitonin, C-reactive protein, LBP, IL-6, IL-10, IL-2R in 61 patients with a high risk of sepsis was investigated starting from the first day after admission to the hospital and then with intervals of 3–5 days. The Group 1 included 29 patients with verified sepsis. All patients of this group survived. The Group 2 included 8 patients who died. The Group 3 included 24 patients who had no clinical signs of sepsis. All the patients in this group recovered. Results. We revealed significant differences in concentrations of systemic inflammatory response markers and its dynamics in the period preceding clinical manifestations of sepsis. It was found that it was possible to predict the development of sepsis and its unfavorable outcome with a high statistical probability in the study of paired samples of blood serum of patients received on day 1–3 and 4–6 from the onset of the disease or severe trauma. The predictors were multidirectional changes of IL-6, IL-10, LBP concentrations and more than three-fold IL-2R increase on the background of high concentrations of procalcitonin and C-reactive protein. Conclusion. The highest concentrations of procalcitonin, C-reactive protein, IL-10 and IL-2R were revealed within the first three days in patients who died of sepsis. High concentrations of IL-6 and IL-10 within first three days and different directions of their concentrations during the next 4–6 days indicate the development of sepsis with an unfavorable outcome. Reduction of IL-2R and IL-6 and an increase in IL-10 within the first week after the onset of the disease or trau-ma are predictors of lethal outcome.
Inflammatory response
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Neopterin
Polytrauma
Procalcitonin
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Objective To observe the dynamic and clinical study of interleukin-12 levels in peripheral venous blood in patients with multiple trauma.Methods ELISA was applied to measure the IL-12 levels in peripheral venous blood in 36 patients with multiple trauma at the first、third、seventh and fourteenth day.15 healthy persons were taken for the control group.Result The IL-12 levels at every time point in patients with multiple trauma were higher than that of the control group (P0.05).The IL-12 levels in the group of ISS≥16 were higher than that of the group of ISS16(P0.05).The IL-12 levels in patients with Systemic Inflammatory Response Syndrome(SIRS)and Multiple Organ Dysfunction Syndrome(MODS)were higher than that of those without SIRS and MODS(P0.05).Conclusion The IL-12 levels in peripheral venous blood in patients with multiple trauma have correlation with the injury severity.The dynamic measure of IL-12 change may have important clinical significance.
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Clinical Significance
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Emergency Surgery
Organ dysfunction
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