Thurs., 10/16/08 Tibia/Polytrauma, Paper #10, 4:08 pm OTA-2008
Early Prognostic Value of Inflammatory Mediators and Laboratory Parameters for Organ Dysfunction and Outcome in Multiple Trauma Patients
Michael Frink, MD (n); Christian Probst, MD (a-Grant by H & S Re Insurance Company,
Grant from Medartis, Basel, Switzerland); Philipp Mommen, MD (n);
Christian Krettek, MD (a-AO Foundation); Frank Hildebrand, MD (n);
Trauma Department, Hannover Medical School, Hannover, Germany
Purpose: Although therapeutic concepts of patients with major trauma have improved during recent years, organ dysfuntion still remains a frequent complication during clinical course in intensive care units. It has previously been shown that cytokines are upregulated under stress conditions such as trauma or sepsis. However, it is still debatable if cytokines are adequate parameters to describe the current state of trauma patients. To elucidate the relevance of cytokines, we investigated if cytokines and other laboratory parameters (thrombocytes, lactate, C-reactive protein [CRP], base excess) predict development of multiorgan dysfunction syndrome (MODS) or outcome.
Methods: In this prospective study, patients with an Injury Severity Score (ISS) >16 and an age >16 years were included. Blood samples for determination of cytokines (interleukin [IL]-6, IL-8, IL-10, IL-1β, and tumore necrosis factor-a) and laboratory parameters (CRP, thrombocytes, lactate, base excess) were drawn over a period of 14 days. Patients were divided into groups according to the development of MODS (+MODS vs –MODS, Marshall Score) and outcome. To determine the association between levels of cytokines and laboratory parameters and development of MODS, the Spearman rank correlation coefficient was calculated and logistic regression and analysis was performed.
Results: 143 patients were included in this study. IL-6 represented the most reliable parameter for predicting the development of MODS, with an overall accuracy of 84.7% (specificity, 98.3%; sensitivity, 16.7%). The threshold value of IL-6 for development of MODS was 761.7 pg/mL and 2176.0 pg/mL for mortality. Among the laboratory parameters, lactate was the most reliable parameter for MODS prediction (overall accuracy, 82.9%; specificity, 97.1%; sensitivity, 7.7%). By combining IL-6, lactate, and thrombocytes, sensitivity was improved to 27.3%. At admission, only systemic IL-6 and lactate levels demonstrated a significant correlation with outcome (specificity: IL-6 100%, lactate 99.0%; sensitivity: IL-6 28.6%, lactate 5.3%). The threshold value of IL-6 for adverse outcome was 2176 pg/mL.
Conclusion: In this study, IL-6 represented the most reliable parameter for assessment of the clinical status. However, the low sensitivity of IL-6 and partly overlapping IL-6 plasma concentrations in patients with or without MODS demonstrate that no single marker alone is able to accurately predict the clinical course and outcome of multiple trauma patients. This is not surprising, as these patients represent a highly diverse group (eg, genetic- or gender-dependent differences). Therefore, laboratory markers (especially lactate), clinical assessment, as well as inflammatory parameters (especially IL-6) should be combined for evaluation of the clinical status.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.