Indicators of the posttraumatic inflammatory response correlate with organ failure in patients with multiple injuries.
BACKGROUND
Most prognostic indices for severely injured patients are based on anatomical findings and the vital signs. The posttraumatic organ failure, however, is thought to be triggered by the initial inflammatory response. The objective of this study was to evaluate the correlation between the early activation of inflammation and the rate of organ failure and death.


METHODS
Sixty-six patients with multiple injuries (Injury Severity Score > 18, age 18-70 years, admission within 6 hours after accident, survival > 48 hours) were included in this prospective study. During a 14-day observation period, serial blood samples were collected starting within 30 minutes after admission. Plasma levels of neutrophil elastase, lactate, antithrombin III, and interleukin-6 and -8 were determined. The clinical course and the degree of organ failure were recorded daily until death or transfer to a general ward.


RESULTS
The 66 severely injured patients had a mean Injury Severity Score of 40 points. Eleven patients died from multiple organ failure (group 1), 38 subjects survived a single or multiple organ failure (group 2), and 17 patients had an uneventful recovery (group 3). The initial plasma concentrations for neutrophil elastase (650 vs. 355 ng/mL), lactate (5.0 vs. 3.1 mmol/L), antithrombin III (48 vs. 62% from normal), interleukin-6 (703 vs. 177 pg/mL), and interleukin-8 (1,101 vs. 301 pg/mL) were significantly different between groups 2 and 3 already in the initial posttraumatic period. Patients from group 1 presented with significantly higher levels of these parameters as early as 24 hours after trauma compared with group 2. Different patterns were identified with respect to early versus late posttraumatic organ failure.


CONCLUSIONS
These data show that the degree of the initial inflammatory response corresponds with the development of posttraumatic organ failure. Besides anatomically and physiologically based trauma scores, these parameters might be used as indicators for the injury severity.
Nast-Kolb
D
D
Department of Surgery, Ludwig-Maximilians-University, Munich, Germany.
Waydhas
C
C
Gippner-Steppert
C
C
Schneider
I
I
Trupka
A
A
Ruchholtz
S
S
Zettl
R
R
Schweiberer
L
L
Jochum
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000990:Antithrombin III / Q000032:analysis; D006801:Humans; D015601:Injury Severity Score; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007773:Lactates / Q000097:blood; D019272:Leukocyte Elastase / Q000097:blood; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000276:immunology* / Q000401:mortality; D009104:Multiple Trauma / Q000097:blood / Q000276:immunology*; D011379:Prognosis; D011446:Prospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000276:immunology*; D013997:Time Factors
D015850:Interleukin-6; D016209:Interleukin-8; D007773:Lactates; D000990:Antithrombin III; D019272:Leukocyte Elastase