title: Measurement of cytokines and adhesion molecules in the first 72 hours after severe trauma: association with severity and outcome.
abstract: BACKGROUND
  Severity and outcome assessments are crucial in trauma. Our aim was to describe the role of a group of cytokines (TNFα, IL-6, IL-10, and HMGB-1) and ICAM-1 as severity and outcome assessment tools and their kinetics in the first 72 h after severe trauma.
  
  
  METHODS
  Authors designed a prospective cohort study of severe polytrauma patients (ISS > 15) in a level 1 Trauma Centre. Cytokines and ICAM-1 levels and Th1/Th2 ratios were assessed at admission, 24, 48, and 72 h. SIRS, SIRS with hypoperfusion, and shock were identified. Outcomes considered were ICU admission, ARDS, MODS, and death.
  
  
  RESULTS
  Ninety-nine patients were enrolled (median ISS: 29 and age 31). There was an early release of pro- and anti-inflammatory mediators with higher values at admission (except for ICAM-1). On admission, IL-6 was associated with ISS, IL-10 with SIRS with hypoperfusion, and HMGB-1 with shock. Several cytokines were associated with outcomes, especially IL-6 and IL-10 at 72 h with MODS and death. Low TNFα/IL-10 and IL-6/IL-10 ratios at 24 and 72 h were associated with MODS and death.
  
  
  CONCLUSIONS
  Pro- and anti-inflammatory responses occur simultaneously and earlier after injury. Cytokines may be useful for outcome assessment, especially IL-6 and IL-10. Low Th1/Th2 ratio at 24 to 72 h is associated with MODS and death.
authors: Centro Hospitalar de São João (CHSJ), Porto, Portugal ; Orthopaedic Department and Emergency and Intensive Care Department, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal.
authors: António
authors: A
authors: Sousa
authors: CHSJ, Orthopaedic Department and Emergency and Intensive Care Department, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal.
authors: Frederico
authors: F
authors: Raposo
authors: CHSJ, Anesthesiology Department, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal.
authors: Sara
authors: S
authors: Fonseca
authors: CHSJ, Orthopaedic Department, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal.
authors: Luís
authors: L
authors: Valente
authors: CHSJ, Orthopaedic Department, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal.
authors: Filipe
authors: F
authors: Duarte
authors: Centro Hospitalar São João, Orthopaedic Department, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal.
authors: Moura
authors: M
authors: Gonçalves
authors: Centro Hospitalar de São João, Clinical Pathology Department, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal.
authors: Diana
authors: D
authors: Tuna
authors: Emergency and Intensive Care Department, Centro Hospitalar Sao Joao, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal ; Faculty of Medicine, University of Porto, Portugal.
authors: José-Artur
authors: JA
authors: Paiva
mesh_terms: D000293:Adolescent; D000328:Adult; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D058408:Th1-Th2 Balance; D014193:Trauma Centers / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000097:blood* / Q000150:complications
chemical_list: D016207:Cytokines; D018799:Intercellular Adhesion Molecule-1