Abstract

Background: The recognition of the relationship between cytokines and outcomes in trauma patients is important. It is possible that early detection of those patients who develop an imbalance in this dual immune response, which would be responsible for subsequent organ dysfunction and susceptibility to infections, allow differential management to reduce the occurrence of such complications.
Methods: An observational cross-sectional study to describe the kinetics of cytokines/chemokines (IL-1B, IL-6, TNF-a, IL-12p70, IL-10, and IL-8) and to explore the possible relationship with the development of infectious complications during the first admission to the hospital in patients with multiple trauma admitted to the emergency room. Serum samples were used to measured cytokines/chemokines. Times of collection were: 0-6 hour’s postrauma, 24 hours and 72 hours postrauma.
Results: 20 consecutive patients were included, 60% were male, the median age was 26.5 years , 90% had a traffic accident, 40% had a severe traumatic brain injury defined as Glasgow less than or equal to 8. The median ISS was 22(17,2–35,2). There was an incidence of shock defined as lactate greater than or equal to 4 of 40%. The admission to ICU was 80%. Of the 16 who entered the ICU, 94% required mechanical ventilation. There was only one hospital death. Cytokines shown to be significantly different between trauma patient’s groups; a greater severity of the trauma in the group that presented infection (ISS 27 vs 17, p=0.011). IL10 on admission and ISS are significantly associated with increased prevalence of infection in this sample of patients with multiple trauma.
Conclusion: Peripheral cytokines could present a method for tracking the course of severe blunt trauma and for better understanding this process. Our results imply that measuring cytokine expression patterns after severe blunt trauma is meaningful to explore and potentially useful in developing innovative approaches for treating acute and subacute trauma.

Keywords

blunt trauma, proinflammatory and anti-inflammatory cytokines, infections, antibiotic treatment, emergency department, corporal areas, tumor necrosis factor alpha, interleukin-6, sepsis, organ dysfunctions, late mortality, systemic inflammatory response syndrome, organ dysfunctions, injury scale, urinary infection