OTA 1997 Posters - Trauma Issues

The Role of Cytokines and Adhesion Molecules in Elective and Traumatic Ischemia/Reperfusion

Andreas Seekamp, MD, Gerd Regel, MD, Frank Martin, MD, Harald Tscherne, MD

Unfallchirurgische Klinik, Hannover, Germany

Purpose: Multiple organ dysfunction (MOD) is still a frequent posttraumatic complication posing a high lethality rate. Cytokines and the interaction of neutrophils and endothelial cells seem to play a major pathophysiological role in MOD. In different experimental models of ischemia/reperfusion injury the role of tumor necrose factor (TNFa), interleukin-1 (IL-1) and interleukin-6 (IL-6) as well as the adhesion molecules ICAM-1 and E-selectin has been identified. In this clinical study the role of different cytokines and two adhesion molecules was investigated in elective ischemia/reperfusion and compared with traumatic ischemia/reperfusion leading to MOD. Methods: The mentioned mediators were investigated in three different groups of patients. The first group (A, n=8) holds patients undergoing elective limb surgery without tourniquet. The second group (B, n=31) includes patients subjected to limb surgery with tourniquet. The third group includes trauma patients (n=30), who later were divided in those with and without having acquired a multi-organ dysfunction (MOD) according to the Moore score.

Results: Elective limb surgery resulted only in a significant increase of IL-6 and IL-10 but not TNFa-R or IL-1-ra when a tourniquet for a mean period time of 90 minutes was used. Apparently this increase was not sufficient to cause an increase of adhesion molecule expression as both sICAM-1 and sE-selectin remained unchanged in group A and B. In trauma patients all parameters increased about 10-fold as compared to group A and B. When the trauma patients where divided by the Moore score for MOD+ (n=8, ISS=32,8) and MOD- (n=22, ISS=31,2), a significant difference was evident in IL-1-ra, IL-6, and IL-10 plasma levels within the first four days after trauma. In these patients (MOD+) the increase in plasma cytokines levels caused a remarkable expression of ICAM-1 and E-selectin as evidenced by significantly increased sICAM-1 and sE-selectin plasma levels in these patients as compared to the MOD group for the first 5 to 6 days.

Discussion: According to our data, cytokines are increased in cases of local ischemia/reperfusion without leading to increased neutrophil accumulation. Therefore, a moderate cytokine release is not leading to clinical signs of organ dysfunction, which is confirmed by daily surgical practice. In trauma patients, cytokines and adhesion molecules are both increased and clearly take part in the onset of multiple organ dysfunction.

Conclusion: Therefore, the cytokines and soluble adhesion molecules measured here, may be of predictive value and also exhibit a potential option for therapeutical approaches in patients at risk of MOD.