Early cytokine production risk stratifies trauma patients for multiple organ failure.
BACKGROUND
Shock is a prime inciting event for postinjury multiple organ failure (MOF), believed to induce a state of injurious systemic inflammation. In animal models of hemorrhagic shock, early (< 24 hours) changes in cytokine production are an index of the systemic inflammatory response syndrome. However, their predictive value in trauma patients remains to be fully elucidated.


METHODS
In a prospective observational pilot study of > 1 year at an urban Level I trauma center, serial (every 4 hours) serum cytokine levels were determined during a 24-hour period using multiplex suspension immunoassay in patients with major torso trauma (excluding severe brain injury) who met criteria for standardized shock resuscitation. Temporal cytokine expression was assessed during shock resuscitation in severe trauma patients to predict risk for MOF. MOF was assessed with the Denver score.


RESULTS
Of 48 study patients (mean age 39 +/- 3 years, 67% men, 88% blunt mechanism, mean Injury Severity Score 25 +/- 2), MOF developed in 11 (23%). MOF patients had a considerably higher mortality (64% versus 3%) and fewer ICU-free days (3.5 +/- 2 versus 17.8 +/- 1.3 days) compared with non-MOF patients. Traditional predictors of MOF, including age (45 +/- 7 versus 38 +/- 3 years; p=0.21), Injury Severity Score (26 +/- 3 versus 25 +/- 2; p=0.67), admission hemoglobin (11.4 +/- 0.9 versus 12.1 +/- 0.5 g/dL; p=0.22), international normalized ratio (1.6 +/- 0.2 versus 1.4 +/- 0.06; p=0.17), and base deficit (9.0 +/- 2 versus 7.1 +/- 0.8; p=0.19), were not significantly different between MOF and non-MOF patients. Statistical analysis identified six candidate predictors of MOF: inducible protein 10, macrophage inflammatory protein-1beta, interleukin-10, interleukin-6, interleukin-1Ra, and eotaxin.


CONCLUSIONS
These data provide insight into cytokine expression during traumatic shock that can enable earlier identification of patients at risk for development of MOF.
Jastrow
Kenneth M
KM
Department of Surgery, University of Texas Medical School at Houston, Houston, TX.
Gonzalez
Ernest A
EA
McGuire
Mary F
MF
Suliburk
James W
JW
Kozar
Rosemary A
RA
Iyengar
Sriram
S
Motschall
Deborah A
DA
McKinley
Bruce A
BA
Moore
Frederick A
FA
Mercer
David W
DW
D000328:Adult; D001499:Bayes Theorem; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D007118:Immunoassay / Q000379:methods; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000145:classification*; D009104:Multiple Trauma; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012769:Shock / Q000097:blood*
D016207:Cytokines