Effects of accidental trauma on cytokine and endotoxin production.
OBJECTIVE
To determine the effects of accidental injury of varying severity on interleukin (IL)-1 alpha, IL-6, IL-8, tumor necrosis factor-alpha (TNF-alpha), and endotoxin release.


METHODS
Prospective, multi-unit, longitudinal study.


METHODS
Emergency Departments and intensive care units of two university hospitals.


METHODS
Trauma patients after mild, moderate, and severe injury (Injury Severity Score of < or = 10, 11 to 24, and > or = 25, respectively).


METHODS
None.


RESULTS
Plasma cytokine and endotoxin concentrations were measured over a 5-day period, starting within 2 hrs of accidental injury. An enzyme-linked immunosorbent assay was used to determine plasma concentrations of IL-1 alpha, IL-6, IL-8, and TNF-alpha. Plasma endotoxin concentrations were measured using a chromogenic limulus amebocyte assay. Preresuscitation samples obtained immediately on arrival in the Emergency Department, and within 2 hrs of injury, demonstrated significant increases of IL-6 and IL-8 concentrations in the severe injury group, in contrast to minimal increases seen after mild or moderate injury. Analysis of serial postresuscitation samples demonstrated rapid increases in IL-6 and IL-8 concentrations within 12 hrs of injury. IL-6 and IL-8 remained increased for 24 hrs after injury, then decreased markedly from their peak values during the next 24 hrs. Increased circulating concentrations of these cytokines continued to be present for > 5 days in the severely injured patients. IL-6 and IL-8 concentrations were only minimally increased in patients 8 and 24 hrs after moderate injury. Endotoxin and IL-1 alpha were not found in any samples, including those samples obtained serially from severely injured patients. No patient at any time point had TNF-alpha concentrations of > 35 pg/mL.


CONCLUSIONS
These results demonstrate that severe injury produces rapid, large increases in circulating concentrations of IL-6 and IL-8 that may contribute to the frequent development of the adult respiratory distress syndrome and multiple organ system failure in this clinical setting.
Department of Medicine, UCLA Medical Center.
R C
RC
Hoch
R
R
Rodriguez
T
T
Manning
M
M
Bishop
P
P
Mead
W C
WC
Shoemaker
E
E
Abraham
D000328:Adult; D004731:Endotoxins / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007375:Interleukin-1 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D016209:Interleukin-8 / Q000097:blood*; D008033:Limulus Test; D008137:Longitudinal Studies; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology; D009104:Multiple Trauma / Q000097:blood* / Q000145:classification / Q000150:complications; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012151:Resuscitation; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
D004731:Endotoxins; D007375:Interleukin-1; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha