[Transcranial cytokine gradient and intestinal permeability in acute severe brain injury].
BACKGROUND
Acute brain injury is associated with a bimodal hypermetabolic state probably caused by cytokine secretion and high hormone and catecholamine concentrations. In a first stage, the brain would produce these substances and afterwards, another production source, most probably the splanchnic territory, would perpetuate the hypermetabolic state.


OBJECTIVE
To investigate the cytokine production source and to assess intestinal permeability in acute brain injury in the absence of cerebral ischemia and systemic oxygen deficit.


METHODS
Arterial systemic and cerebral venous bulbar interleukin 1 beta and interleukin 6 levels were measured during the first seven days of evolution in 15 patients with acute brain injury. Serum lactate, the oxygen/lactate ratio, gastric intramucosal pH and intestinal permeability using the lactulose/mannitol test were also assessed in the same period.


RESULTS
High arterial and venous interleukin 1 beta and interleukin 6 levels were detected. A positive gradient for interleukin 6 levels was detected throughout the study period with normal intramucosal pH, lactate and oxygen/lactate ratio. There was also an early impairment of intestinal permeability in these patients.


CONCLUSIONS
High arterial and venous cytokine concentrations were detected in patients with acute brain injury. The positive gradient for interleukin 6 suggests a brain origin for this cytokine. Intestinal permeability is also altered in these patients.
Castillo
L
L
Departamento de Anestesiología, Facultad de Medicina y Hospital Clínico de la Universidad Católica, Santiago de Chile. castillo@med.puc.cl
Velasco
N
N
Wainstein
C
C
Bugedo
G
G
Hernández
G
G
Klaassen
J
J
Errandonea
M
M
Méndez
J
J
Acosta
A M
AM
D000328:Adult; D001930:Brain Injuries / Q000378:metabolism*; D016207:Cytokines / Q000097:blood* / Q000378:metabolism; D005260:Female; D006801:Humans; D007375:Interleukin-1 / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism; D007413:Intestinal Mucosa / Q000378:metabolism*; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D010539:Permeability; D011446:Prospective Studies; D012720:Severity of Illness Index
D016207:Cytokines; D007375:Interleukin-1; D015850:Interleukin-6; D019344:Lactic Acid