title: Pattern of cytokine (IL-6 and IL-10) level as inflammation and anti-inflammation mediator of multiple organ dysfunction syndrome (MODS) in polytrauma.
abstract: Massive injury remains the most common cause of death for productive age group globally. The current immune, inflammatory paradigm, based on an incomplete understanding of the functional integration of the complex host response, remains a major impediment to the development of effective innovative diagnostic and therapeutic effort. This study attempt to investigate the pattern of inflammatory and anti-inflammatory cytokines such as interleukin-6 and 10 (IL-6 and IL-10) and their interaction in severe injury condition with its major complication as multiple organ dysfunction syndrome (MODS) and failure (MOF) after polytrauma. This is multicenter study held at 4 academic Level-1 Trauma center included 54 polytrauma participants. Inclusion criteria were age between 16-60 years old, had new acute episode of polytrauma which defined as injury in ≥2 body region with Injury Severity Score (ISS) ≥16, and the presence of Systemic Inflammation Response Syndrome (SIRS). Serum level of IL-6 and IL-10 were taken on day 2, 3, and 5 after trauma. During hospitalization, samples were observed for the occurrence of MODS or MOF using Sequential Organ Failure Assessment (SOFA) and mortality rate were also noted. Participant were mostly male with mean of age of 35, 9 years old, endured polytrauma caused by traffic accident. Elevation of cytokines (IL-6, IL-10, and IL-6/IL-10 ratio) had directly proportional with MODS and mortality. Threshold level of compensation for severe trauma is IL-6 of 50 pg/mL and trauma load of ISS ≥30. Inflammation reaction greater than this threshold level would result in downhill level of IL-6, IL-10, or IL-6/IL-10 ratio which associated with poor outcome (MODS and death). The elevation of these cytokines level were represent as compensation/adaptive immune system and its fall represent decompensating/failure of immune system after severe trauma. The pattern of IL-6 and IL-10 after polytrauma represent immune system effort to restore homeostasis. Besides cytokines interaction, there must be other factors that contribute to mortality and poor outcome after major trauma. Further study is needed to investigate genomic variant or polymorphism related to trauma.
authors.affiliation: Department of Surgery, Faculty of Medicine, Sam Ratulangi University Manado, Indonesia.
authors.forename: Heber Bombang
authors.initials: HB
authors.lastname: Sapan
authors.affiliation: Department of Orthopedic and Traumatology, Faculty of Medicine, University of Hasanuddin School of Medicine Makassar, Indonesia.
authors.forename: Idrus
authors.initials: I
authors.lastname: Paturusi
authors.affiliation: Department of Physiology, Faculty of Medicine, University of Hasanuddin Makassar, Indonesia.
authors.forename: Irawan
authors.initials: I
authors.lastname: Jusuf
authors.affiliation: Department of Physiology, Faculty of Medicine, University of Hasanuddin Makassar, Indonesia.
authors.forename: Ilhamjaya
authors.initials: I
authors.lastname: Patellongi
authors.affiliation: Department of Microbiology, Faculty of Medicine, University of Hasanuddin Makassar, Indonesia.
authors.forename: Muh Nasrum
authors.initials: MN
authors.lastname: Massi
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Indonesia Jakarta, Indonesia.
authors.forename: Aryono Djuned
authors.initials: AD
authors.lastname: Pusponegoro
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, University of Hasanuddin Makassar, Indonesia.
authors.forename: Syafrie Kamsul
authors.initials: SK
authors.lastname: Arief
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Hasanuddin Makassar, Indonesia.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Labeda
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Hasanuddin Makassar, Indonesia.
authors.forename: Andi Asadul
authors.initials: AA
authors.lastname: Islam
authors.affiliation: Department of Surgery, Faculty of Medicine, Sam Ratulangi University Manado, Indonesia.
authors.forename: Leo
authors.initials: L
authors.lastname: Rendy
authors.affiliation: Molecular Biology and Immunology Laboratory, Faculty of Medicine, University of Hasanuddin Makassar, Indonesia.
authors.forename: Mochammad
authors.initials: M
authors.lastname: Hatta
keywords: IL10; IL6; Multiple organ dysfunction syndrome; polytrauma