title: Lipopolysaccharide-induced tumor necrosis factor alpha production and not monocyte human leukocyte antigen-DR expression is correlated with survival in septic trauma patients.
abstract: Multiple trauma patients have an impaired immune system and thus frequently develop life-threatening septic complications. Because there is an ongoing debate on which are the most predictive immunologic parameters of clinical outcome, we prospectively studied 19 multiple trauma patients with sepsis (mean age, 38.7 +/- 15.8 years; mean Injury Severity Score, 40.6 +/- 11.6) over a period of 14 days. The following parameters were measured daily after admission to the intensive care unit: ex vivo lipopolysaccharide (LPS)-induced tumor necrosis factor alpha (TNF-alpha) production, monocyte human leukocyte antigen (HLA)-DR expression, constitutive interleukin (IL) 6 secretion, white blood cell count, and C-reactive protein. In addition, procalcitonin, neopterin, LPS-binding protein, and constitutive TNF-alpha secretion were measured every third day. Immediately after trauma, all patients had significantly lower levels of HLA-DR and ex vivo LPS-stimulated TNF-alpha secretion than healthy controls (n = 7; P < 0.001). On the day after clinical diagnosis of sepsis, before any other parameter differed between survivors (n = 13) and nonsurvivors (n = 6), ex vivo LPS-induced TNF-alpha secretion was significantly lower (P < 0.05) in nonsurvivors than in survivors. We conclude that ex vivo LPS-induced TNF-alpha production is an earlier predictor of clinical outcome in multiple trauma patients with sepsis than monocyte HLA-DR expression, constitutive IL-6 secretion, or any other parameter assessed.
authors.affiliation: Surgical Research Laboratories, Medical University Of Vienna, 8H G9.13 Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Ploder
authors.forename: Linda
authors.initials: L
authors.lastname: Pelinka
authors.forename: Claudia
authors.initials: C
authors.lastname: Schmuckenschlager
authors.forename: Barbara
authors.initials: B
authors.lastname: Wessner
authors.forename: Hendrik Jan
authors.initials: HJ
authors.lastname: Ankersmit
authors.forename: Walter
authors.initials: W
authors.lastname: Fuerst
authors.forename: Heinz
authors.initials: H
authors.lastname: Redl
authors.forename: Erich
authors.initials: E
authors.lastname: Roth
authors.forename: Andreas
authors.initials: A
authors.lastname: Spittler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001798:Blood Proteins / Q000096:biosynthesis; D002478:Cells, Cultured; D005260:Female; D005786:Gene Expression Regulation / Q000187:drug effects*; D006684:HLA-DR Antigens / Q000096:biosynthesis*; D006801:Humans; D008070:Lipopolysaccharides / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000378:metabolism* / Q000473:pathology; D009104:Multiple Trauma / Q000150:complications / Q000378:metabolism* / Q000401:mortality / Q000473:pathology; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018805:Sepsis / Q000209:etiology / Q000378:metabolism* / Q000401:mortality / Q000473:pathology
chemical_list: D001798:Blood Proteins; D006684:HLA-DR Antigens; D008070:Lipopolysaccharides