Posttraumatic immune modulation in chronic alcoholics is associated with multiple organ dysfunction syndrome.
BACKGROUND
Patients with chronic alcohol abuse constitute approximately 50% of trauma care patients, and these patients have a two- to fourfold increase in posttraumatic infectious complications. Cytokines such as interleukin-6 (IL-6) and interleukin-10 (IL-10) and the adhesion molecule soluble endothelial selectin (sE-selectin) have been found to play an important role in the initial inflammatory response to trauma and the development of early and late multiple organ dysfunction syndrome (MODS). The aim of this study was to compare the immune modulation and clinical relevance between chronic alcoholic and nonalcoholic patients following trauma.


METHODS
Sixty-three patients (37 alcohol abusers, 26 nonalcoholics) were included in this prospective controlled study. IL-6, IL-10, and sE-selectin were determined on admission and on days 2, 4, and 7 following admission to the ICU.


RESULTS
On admission to the ICU but not on the following days of the study period, plasma IL-6, IL-10, and sE-selectin were significantly elevated in chronic alcoholic patients compared with nonalcoholics. The incidence of MODS was significantly higher in chronic alcoholic patients (89% vs. 50%, p < 0.01), whereas the incidence of pneumonia (35% vs. 19%, p < 0.17) and sepsis (14% vs. 0%, p < 0.07) did not reach statistical significance.


CONCLUSIONS
The significantly elevated levels of IL-6, IL-10, and sE-selectin in chronic alcoholic trauma patients on admission to the ICU could play an important role in the development of MODS in intensive care. In patients with high levels of inflammatory mediators, immune modulatory treatment before the development of MODS may be considered.
von Heymann
Christian
C
Department of Anesthesiology and Intensive Care Medicine, Universitätsklinikum Charité Campus Mitte, Humboldt-University, Berlin, Germany.
Langenkamp
Jörg
J
Dubisz
Norman
N
von Dossow
Vera
V
Schaffartzik
Walter
W
Kern
Hartmut
H
Kox
Wolfgang J
WJ
Spies
Claudia
C
D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000097:blood / Q000150:complications* / Q000276:immunology*; D019040:E-Selectin / Q000097:blood; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000209:etiology* / Q000276:immunology*; D011014:Pneumonia / Q000097:blood / Q000209:etiology / Q000276:immunology; D018805:Sepsis / Q000097:blood / Q000209:etiology / Q000276:immunology; D014947:Wounds and Injuries / Q000097:blood / Q000150:complications* / Q000276:immunology*
D019040:E-Selectin; D015850:Interleukin-6; D016753:Interleukin-10