title: Early alveolar and systemic mediator release in patients at different risks for ARDS after multiple trauma.
abstract: Alveolar IL-8 has been reported to early identify patients at-risk to develop ARDS. However, it remains unknown how alveolar IL-8 is related to pulmonary and systemic inflammation in patients predisposed for ARDS. We studied 24 patients 2-6h after multiple trauma. Patients with IL-8 >200 pg/ml in bronchoalveolar lavage (BAL) were assigned to the group at high risk for ARDS (H, n = 8) and patients with BAL IL-8 <200 pg/ml to the group at low risk for ARDS (L, n = 16). ARDS developed within 24h after trauma in 5 patients at high and at least after 1 week in 2 patients at low risk for ARDS (p = 0.003). High-risk patients had also increased BAL IL-6, TNF-α, IL-1β, IL-10 and IL-1ra levels (p<0.05). BAL neutrophil counts did not differ between patient groups (H vs. L, 12% (3-73%) vs. 6% (2-32%), p = 0.1) but correlated significantly with BAL IL-8, IL-6 and IL-1ra. High-risk patients had increased plasma levels of pro- but not anti-inflammatory mediators. The enhanced alveolar and systemic inflammation associated with alveolar IL-8 release should be considered to identify high-risk patients for pulmonary complications after multiple trauma to adjust surgical and other treatment strategies to the individual risk profile.
authors.affiliation: Department of Anaesthesiology, Medical School Hannover, Germany. Raymondos@ardseu.de
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Raymondos
authors.forename: Michael U
authors.initials: MU
authors.lastname: Martin
authors.forename: Tanja
authors.initials: T
authors.lastname: Schmudlach
authors.forename: Stefan
authors.initials: S
authors.lastname: Baus
authors.forename: Christian
authors.initials: C
authors.lastname: Weilbach
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.forename: Christian
authors.initials: C
authors.lastname: Krettek
authors.forename: Michael
authors.initials: M
authors.lastname: Frink
authors.forename: Frank
authors.initials: F
authors.lastname: Hildebrand
mesh_terms: D000328:Adult; D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000276:immunology*; D004198:Disease Susceptibility; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein / Q000276:immunology; D016753:Interleukin-10 / Q000276:immunology; D016209:Interleukin-8 / Q000276:immunology; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000276:immunology* / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000276:immunology* / Q000401:mortality / Q000503:physiopathology; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology; D055815:Young Adult
chemical_list: D053590:Interleukin 1 Receptor Antagonist Protein; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10