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

Abstract

IntroductionSevere 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 studySevere 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 methodsThe 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.ResultsEvaluation 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.

Effects of Anesthesia on Innate Immune Components in Orthopedic Surgery

“…The explanation for that is that the main difference between male and female patients is represented by certain hormonal levels, namely estrogen, progesterone, and testosterone, and these hormones have no effect on the level of inflammatory mediators [5]. The current study showed no significant correlation between any of the cytokines and age of the patients which are in agreement with Gołąbek-Dropiewska et al [21]. The explanation for the lack of significant correlation between these cytokines and the age of the patient is most likely due to a relatively small sample size; however, substantial amount of published literature documents the negative correlation between age and immune markers due to the concept of aging of the immune system [22].…”

Impact of Injury Severity on the Inflammatory State and Severe Anemia

“…31 Plasma CRP concentration was significantly elevated in all four trauma groups. Golabek-Dropiewska et al 20 found that there was a correlation between elevated CRP level and the occurrence of infectious complications in severely injured trauma patients. While, Alper et al 32 demonstrated that mean CRP on admission was significantly higher in trauma patients compared with controls, CRP did not directly correlate with ISS and therefore was not helpful in predicting injury severity or outcomes.…”

“…The role of cytokines in the inflammatory response is well described as they activate, modulate, and inhibit inflammation in response to tissue damage, but their role in the bone marrow response to anemia is not as well understood. 20 This study was limited by small sample sizes, data from a single institution, and the lack of serial biochemical peripheral blood analyses. Although sample sizes were small, the results suggest that enrollment was adequate.…”

“…[15][16][17][18] IL-6 has been found to upregulate hepcidin expression, thereby leading to the sequestration of iron within macrophages, which can play a role in the persistent anemia seen in severely injured trauma patients, and it also activates secretion of C-reactive protein (CRP), which contributes to a systemic inflammatory state. 19,20 Dysfunctional erythropoiesis in a rodent trauma model can be ameliorated with chemical sympathectomy using either propranolol or clonidine, suggesting that a reduction of hypercatecholaminemia improves erythropoiesis. [11][12][13][21][22][23][24][25][26] Prior research has evaluated the postinjury inflammatory state in severely injured trauma patients and demonstrated their erythropoietic dysfunction and iron dysregulation.…”

Effect of Beta-Blockade on the Expression of Regulatory MicroRNA after Severe Trauma and Chronic Stress

“…[16][17][18][19] IL-6 upregulates hepcidin production, leading to the sequestration of iron in macrophages, and also activates secretion of CRP. 20,21 Norepinephrine, a key modulator of hematopoietic progenitor mobilization and an inhibitor of bone marrow erythroid cell growth at high levels, also directly stimulates IL-6 release. 22 IL-1b and IL-6 levels have also been found to be increased early after traumatic brain injury, and there are marked alterations in the NO pathway after HS, along with enhanced formation of NO after systemic inflammation.…”