The diagnostic value of early cytokine response in patients after major trauma - preliminary report

Abstract

This study was aimed to give a better understanding of the mechanisms of early immune response to trauma by assessing the concentration of cytokines in peripheral blood. The study group comprised 32 patients admitted to the Emergency Department due to injury. Depending on the magnitude of the Injury Severity Score (ISS) trauma patients were divided into two groups. In group A (ISS ≥ 20), 13 patients had complications, and five died, while in group B (ISS < 20) only three patients had complications (e.g. respiratory failure and infections). Depending on the extent of the injury, significant differences were observed in the concentrations of cytokines in the treatment groups. The highest levels of IL-6 and IL-1Ra in both groups were recorded in the third hour of hospitalisation and were considerably higher in group A compared to the concentration of these cytokines in group B (p = 0.001). In patients with complications, IL-6 and IL-1Ra concentrations were significantly higher compared to those without complications. Spearman's rho-correlation showed a statistically significant positive correlation between baseline concentrations of IL-6 (r = 0.64, p < 0.001) and IL-1Ra (r = 0.37, p = 0.042) and the values of the ISS. A high diagnostic sensitivity calculated from ROC curves was found for IL-6 concentrations. In summary, our findings suggest that elevated levels of the cytokines tested, determined in the peripheral blood shortly after injury, may be significantly associated with the occurrence of severe complications, which in some patients can lead to death. Monitoring the levels of these cytokines in patients with a high risk of serious complications should be used routinely.

Keywords: IL-1Ra; IL-6; MODS; inflammation; sepsis; trauma.

Fig. 1

IL-6 concentration (pg/ml) in relation to the extent of the injury (according to the Injury Severity Score [ISS] score). *p < 0.05; group A ISS ≥ 20; group B ISS < 20

Fig. 2

IL-1Ra concentration (pg/ml) in relation to the extent of the injury (according to the Injury Severity Score [ISS] score). *p < 0.05, group A ISS ≥ 20; group B ISS < 20

Fig. 3

IL-6 concentration [pg/ml] in relation to the complications. *p < 0.05, post-traumatic complications (C⁺), without complications (C^–)

Fig. 4

IL-1Ra concentration [pg/ml] in relation to the complications. *p < 0.05 post-traumatic complications (C⁺), without complications (C^–)

Fig. 5

Correlation plot between baseline levels of IL-6 and the Injury Severity Score (ISS) scores

Fig. 6

Correlation plot between baseline levels of IL-1Ra and the Injury Severity Score (ISS) scores

Fig. 7

Prognostic value for serum IL-6 and IL-1Ra levels in the whole group of patients after trauma (ROC curve)