title: Early inflammatory response in polytraumatized patients: Cytokines and heat shock proteins. A pilot study.
abstract: BACKGROUND
  In the initial phases after polytrauma there is an hyperinflammatory state that sometimes leads to multiple organ dysfunction syndrome (MODS) and death, and that appears to be responsible for posttraumatic immunosuppression; among the trigger endogenous stimuli, heat shock proteins (HSPs) have been proposed. The objectives of this study were to analyze if some inflammatory mediators can be considered prognostic biomarkers of outcome, and the possible role of HSPA1A in posttraumatic immunosuppression.
  
  
  OBJECTIVE
  Cytokines and HSPs could be early prognostic biomarkers of inflammatory and immune response in polytrauma patients.
  
  
  METHODS
  A prospective observational descriptive pilot study was carried out, evaluating the early inflammatory and stress response of 18 polytraumatized patients (ISS>16) on hospital admission, at 12hours, 24hours, and 48hours posttrauma. Variable means were compared using non-parametric tests; qualitative and quantitative variables were analyzed using a Spearman's correlation test.
  
  
  RESULTS
  Seven patients met criteria for MODS. Statistically significant changes were recorded in leukocyte count, C-reactive-protein (CRP), IL-6, TNF-α, and IL-1ß concentrations. HSPA1A levels were significantly higher immediately after the accident followed by gradual lowering. Anti-Hsp70 antibodies showed a significant reduction in all the studied time-points. MODS did not influence either plasma levels of leukocytes, fibrinogen, RCP or anti-Hsp70, but patients with MODS had higher plasma levels of IL-6 and TNF-α and a slower decrease of HSPA1A concentrations.
  
  
  CONCLUSIONS
  The higher serum concentrations of TNF-α and IL-6 found in patients with MODS, suggests a possible role as potential early predictive markers for systemic inflammatory response and clinical complications. The higher levels of HSPA1A in patients with MODS, allows proposing HSPA1A as a useful prognostic trauma biomarker early after severe injury and to consider a "damage control surgery". The significant reduction in the levels of anti-Hsp70 antibodies could reflect a part of posttraumatic immunosuppression and hydrocortisone treatment might be suggested.
  
  
  METHODS
  
  
  
  METHODS
  case-control study.
authors.affiliation: Medicina y Cirugía Experimental, Hospital General Universitario "Gregorio Marañón", Dr. Esquerdo 46, 28007 Madrid, Spain; Facultad de Medicina, UCM, Madrid, Spain. Electronic address: mguisasola@mce.hggm.es.
authors.forename: M C
authors.initials: MC
authors.lastname: Guisasola
authors.affiliation: Cirugía Ortopédica y Traumatología, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Ortiz
authors.affiliation: Cirugía Ortopédica y Traumatología, Hospital General Universitario "Gregorio Marañón", Madrid, Spain; Facultad de Medicina, UCM, Madrid, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Chana
authors.affiliation: Cirugía Ortopédica y Traumatología, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Alonso
authors.affiliation: Cirugía Ortopédica y Traumatología, Hospital General Universitario "Gregorio Marañón", Madrid, Spain; Facultad de Medicina, UCM, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Vaquero
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D016022:Case-Control Studies; D016207:Cytokines / Q000097:blood*; D042241:Early Diagnosis; D005260:Female; D018840:HSP70 Heat-Shock Proteins / Q000097:blood*; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000097:blood*; D010865:Pilot Projects; D011446:Prospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis*; D013997:Time Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D016207:Cytokines; D018840:HSP70 Heat-Shock Proteins; C490786:HSPA1A protein, human; D002097:C-Reactive Protein
keywords: Cytokines; Heat shock proteins; Inflammatory response; Polytrauma; Posttraumatic immunosuppresion