title: An adequately robust early TNF-alpha response is a hallmark of survival following trauma/hemorrhage.
abstract: BACKGROUND
  Trauma/hemorrhagic shock (T/HS) results in cytokine-mediated acute inflammation that is generally considered detrimental.
  
  
  RESULTS
  Paradoxically, plasma levels of the early inflammatory cytokine TNF-alpha (but not IL-6, IL-10, or NO(2) (-)/NO(3) (-)) were significantly elevated within 6 h post-admission in 19 human trauma survivors vs. 4 non-survivors. Moreover, plasma TNF-alpha was inversely correlated with Marshall Score, an index of organ dysfunction, both in the 23 patients taken together and in the survivor cohort. Accordingly, we hypothesized that if an early, robust pro-inflammatory response were to be a marker of an appropriate response to injury, then individuals exhibiting such a response would be predisposed to survive. We tested this hypothesis in swine subjected to various experimental paradigms of T/HS. Twenty-three anesthetized pigs were subjected to T/HS (12 HS-only and 11 HS + Thoracotomy; mean arterial pressure of 30 mmHg for 45-90 min) along with surgery-only controls. Plasma obtained at pre-surgery, baseline post-surgery, beginning of HS, and every 15 min thereafter until 75 min (in the HS only group) or 90 min (in the HS + Thoracotomy group) was assayed for TNF-alpha, IL-6, IL-10, and NO(2) (-)/NO(3) (-). Mean post-surgery+/-HS TNF-alpha levels were significantly higher in the survivors vs. non-survivors, while non-survivors exhibited no measurable change in TNF-alpha levels over the same interval.
  
  
  CONCLUSIONS
  Contrary to the current dogma, survival in the setting of severe, acute T/HS appears to be associated with an immediate increase in serum TNF-alpha. It is currently unclear if this response was the cause of this protection, a marker of survival, or both. This abstract won a Young Investigator Travel Award at the SHOCK 2008 meeting in Cologne, Germany.
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Rajaie
authors.initials: R
authors.lastname: Namas
authors.forename: Ali
authors.initials: A
authors.lastname: Ghuma
authors.forename: Andres
authors.initials: A
authors.lastname: Torres
authors.forename: Patricio
authors.initials: P
authors.lastname: Polanco
authors.forename: Hernando
authors.initials: H
authors.lastname: Gomez
authors.forename: Derek
authors.initials: D
authors.lastname: Barclay
authors.forename: Lisa
authors.initials: L
authors.lastname: Gordon
authors.forename: Sven
authors.initials: S
authors.lastname: Zenker
authors.forename: Hyung Kook
authors.initials: HK
authors.lastname: Kim
authors.forename: Linda
authors.initials: L
authors.lastname: Hermus
authors.forename: Ruben
authors.initials: R
authors.lastname: Zamora
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Rosengart
authors.forename: Gilles
authors.initials: G
authors.lastname: Clermont
authors.forename: Andrew
authors.initials: A
authors.lastname: Peitzman
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Billiar
authors.forename: Juan
authors.initials: J
authors.lastname: Ochoa
authors.forename: Michael R
authors.initials: MR
authors.lastname: Pinsky
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Puyana
authors.forename: Yoram
authors.initials: Y
authors.lastname: Vodovotz
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009566:Nitrates / Q000097:blood; D009573:Nitrites / Q000097:blood; D012771:Shock, Hemorrhagic / Q000097:blood* / Q000150:complications; D016019:Survival Analysis; D034421:Sus scrofa; D013908:Thoracotomy; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
chemical_list: D009566:Nitrates; D009573:Nitrites; D014409:Tumor Necrosis Factor-alpha