Measurement of Cytokines and Adhesion Molecules in the First 72 Hours after Severe Trauma: Association with Severity and Outcome

الملخص EN

Introduction.

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.

Materials and Methods.

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.

Results.

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.

Conclusions.

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.