Analysis of selected pro- and anti-inflammatory cytokines in patients with multiple injuries in the early period after trauma

Abstract

Introduction: Severe trauma causes damage to the protective barriers of the organism, and thus activates immunological reaction. Among substances secreted during this process pro-inflammatory cytokines are of high importance.

The aim of the study: Severe trauma causing multiple injuries is more likely to lead to particularly intensive inflammatory reaction, which can sometimes lead to serious complications, even life-threatening. The aim of the study is to determine those parameters which may serve as predictors of infectious complications and to enable estimation of the patient's immunological status before the decision to introduce elective procedures.

Material and methods: The study population included patients with multiple trauma treated in the Department of Trauma Surgery of the Medical University of Gdańsk. The severity of injuries was evaluated with commonly used numerical scales (Revised Trauma Score - RTS, Injury Severity Score - ISS, Glasgow Coma Scale - GCS). Blood samples were collected on the first, second, and fifth day after injury. Evaluated parameters: C-reactive protein (CRP), the level of cytokines: IL-8, IL-1β, IL-6, TNF, IL-12p70, and IL-10. Control population: individuals without injury.

Results: Evaluation of IL-6, IL-8, and CRP levels in patients with multiple trauma in the early period after injury (2-3 days) could be considered as a predictor of delayed infection (5-10 days). CRP level, being cheap and commonly accessible, can be used in clinical practice enabling identification of patients at higher risk of infectious complications and introduction of appropriate treatment and prevention. The analysis of the mentioned parameters may contribute to choosing an appropriate management strategy, including "timing" depending on the patient's biological status.

Keywords: (Centr Eur Immunol 2018; 42-49); 43 (1); CRP; cytokines; infectious complications; inflammation; multiple injuries.

Fig. 1

Box-and-whisker plots present the differences between A) IL-6 level on the first, second, and fifth day after injury, B) IL-8 level on the first, second, and fifth day after injury, C) CRP levels in particular days after injury

Fig. 2

A) Levels of IL-8 on the fifth day after the injury in the different age ranges. B) Levels of IL-6 on the first day after injury in different groups according to Injury Severity Score (ISS) values. C) Levels of IL-10 on the first day after injury in different groups according to ISS values

Fig. 3

Box-and-whisker plots present: A) IL-8 levels on the first day after injury, depending on the prevalence of abdominal injuries; B) IL-10 levels on the second day after injury, depending on the prevalence of abdominal injuries; C) IL-6 levels on the first day after injury, depending on the prevalence of limbs injuries

Fig. 4

Box-and-whisker plots present: levels of IL-8 in the fifth day after injury (A), IL-6 in the first day after injury (B), and C-reactive protein (CRP) in the second day after injury (C), depending on the prevalence of infectious complications