[Clinical course and prognostic significance of immunological and functional parameters after severe trauma].
Generalized severe trauma leads to an increased incidence of SIRS, sepsis, and MOF. The aim of this prospective study was to investigate the immunological parameters in terms of their predictive value for multiple organ failure (MOF).HLA-DR expression on peripheral monocytes was analyzed by flow cytometry, the ex vivo endotoxin-stimulated TNFalpha synthesis of whole blood, and the serum levels of IL-6, IL-10, procalcitonin (PCT), and CRP were analyzed by ELISA in 16 severely injured patients with an ISS >25. Initially after trauma elevated serum levels of IL-6, IL-10, and PCT were found, while TNFalpha-producing capacity and HLA-DR expression on monocytes decreased. In patients with MOF a further decrease of HLA-DR expression on days 3-4 after injury was observed accompanied by elevated levels of IL-10 at this time point. However, the TNFalpha-producing capacity was even enhanced in patients with MOF in the 2nd week after trauma. Later PCT levels were also higher in patients with MOF.Monitoring of immunological parameters after severe injury is useful to identify mediator constellations that are associated with the development and clinical course of MOF even in extremely injured patients.
Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum, Hufelandstrasse 55, 45122 Essen, Germany. sven.lendemans@uni-essen.de
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Lendemans
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Kreuzfelder
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Waydhas
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Nast-Kolb
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Flohé
D015998:Abbreviated Injury Scale; D000328:Adult; D000368:Aged; D003422:Critical Care; D005260:Female; D006684:HLA-DR Antigens / Q000097:blood; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009102:Multiple Organ Failure / Q000175:diagnosis* / Q000276:immunology; D009104:Multiple Trauma / Q000175:diagnosis* / Q000276:immunology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis* / Q000276:immunology
D006684:HLA-DR Antigens; D018836:Inflammation Mediators