title: Immediate IL-10 expression following major orthopaedic trauma: relationship to anti-inflammatory response and subsequent development of sepsis.
abstract: OBJECTIVE
  To assess the relationship between IL-10 release and anti-inflammatory response following blunt trauma.
  
  
  METHODS
  Prospective longitudinal clinical study.
  
  
  METHODS
  Departments of trauma and anaesthetics in a university teaching hospital.
  
  
  METHODS
  Forty-eight adult patients with a mean injury severity score of 14.5 (range 9-57) were prospectively studied following blunt trauma.
  
  
  RESULTS
  Venous blood samples were collected on arrival and at 16 and 24 h, and at 3, 5, and 7 days. Peripheral blood mononuclear cell (HLA-DR) expression on CD14 + monocytes was quantified by flow cytometry and serum IL-10 was assayed by ELISA. Anti-inflammatory response was defined as monocyte HLA-DR expression of less than 30% of that seen in healthy controls. Serum IL-10 levels in trauma patients on arrival was significantly elevated, 70.0 [48.0-92.1, 95% confidence interval, (CI)] compared to the control group, 3 (0-5) (P < 0.0001), and monocyte HLA-DR expression was significantly lower, 14.2 (12.1-16.3, 95% CI), in patients versus 25.2 (22.4-28.1) in controls (P < 0.001). Patients with low HLA-DR expression (n = 14) had significantly higher serum IL-10 levels than those whose HLA-DR expression remained above 30% of the control value (n = 34), (P < 0.038). In patients who developed sepsis (n = 11), serum IL-10 levels were greater on admission, [143.7 (80.2-207.2) pg/ml(-1)], and remained elevated during the study period compared with non-complicated patients, [50.16 (33.5-66.8) pg/ml(-1)]. Immediate IL-10 (2 h following trauma) was negatively correlated with simultaneous HLA-DR expression, (r = -0.49, P = 0.0005).
  
  
  CONCLUSIONS
  These findings support the view that IL-10 release regulates monocyte HLA-DR expression and may be related to an anti-inflammatory response and development of sepsis following trauma.
authors.affiliation: Intensive Care Unit, St James's University Hospital, Leeds, UK.
authors.forename: P V
authors.initials: PV
authors.lastname: Giannoudis
authors.forename: R M
authors.initials: RM
authors.lastname: Smith
authors.forename: S L
authors.initials: SL
authors.lastname: Perry
authors.forename: A J
authors.initials: AJ
authors.lastname: Windsor
authors.forename: R A
authors.initials: RA
authors.lastname: Dickson
authors.forename: M C
authors.initials: MC
authors.lastname: Bellamy
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016022:Case-Control Studies; D006684:HLA-DR Antigens / Q000097:blood; D006801:Humans; D015601:Injury Severity Score; D016753:Interleukin-10 / Q000097:blood*; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000209:etiology / Q000276:immunology*; D013997:Time Factors; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000276:immunology*
chemical_list: D006684:HLA-DR Antigens; D016753:Interleukin-10