Session VII - Polytrauma
Sat, 10/9/04 Polytrauma, Paper #38, 10:42 am
Pro- and Anti-Inflammatory Cytokines in Blunt Trauma and Posttraumatic Surgery: Do They Indicate Development of Multiple Organ Dysfunction Syndrome (MODS)?
Purpose: Multiple-organ dysfunction syndrome (MODS) continues to be a major complication in polytraumatized patients. The pathogenesis is thought to be triggered by the early inflammatory response with synthesis of pro- and antiinflammatory cytokines, such as Interleukin-6 (IL-6) and Interleukin-10 (IL-10). The objective of this study was to evaluate the association between the pro- and antiinflammatory response after severe blunt trauma.
Methods: Polytraumatized patients were consecutively included in this prospective study. Inclusion criteria included Injury Severity Score (ISS) >16; age 18 to 60 years; admission within 6 hours after accident; and survival >48 hours. Over a 14-day observation period, blood samples were drawn once daily for determination of IL-6 and IL-10 concentrations (ELISA, R&D Systems, Germany). The first sample was taken within the first 45 minutes after admission but always before the first surgical treatment. The clinical course was also recorded daily. The presence of MODS was evaluated by using the Marshall score (MODS is defined as >12 points on two consecutive days or on three days over the observation period). Analysis of variance was performed as well as a subsequent two-sided t-test; statistical significance was set at P <0.05.
Results: A total of 110 severely injured patients aged 34.0 ± 12.5 were included in this study; they had an average ISS of 26.3 ± 8.9. Patients were divided in two groups according to the development of MODS; 90 patients did not develop MODS, and 20 patients did. Age and sex distribution were comparable in both groups. Injury Severity Score, intensive care unit stay and the number of major operations (duration of >100 minutes) in the early posttraumatic course were significantly higher in patients who developed MODS. The time course of IL-6 concentrations was significantly increased in +MODS patients over the entire study period, with the most significant differences from day 0 to day 3. Concentrations of IL-10-serum increased again in +MODS patients from day 6 to day 14 with significantly higher levels from day 1 to day 4 and from day 6 to day 14.
Conclusion: The early increase of IL-6 serum concentrations and the secondary increase of IL-10 levels from day 4 on seem to be associated with the later development of MODS. The results of this study reconfirm systemic IL- 6 levels to represent adequate markers for severity of trauma and posttraumatic surgery. For the clinical development of MODS (increase of MODS score from day 4 to day 9), IL-10 appears to play a major role, thus representing a dysergic reaction with an increased anti-inflammatory response in the later course after trauma.