Bronchoalveolar lavage fluid cytokine bead array profile for prognostication of ventilated trauma patients.
OBJECTIVE
Ventilator-associated pneumonia (VAP) is a common cause of mortality in trauma patients admitted to Intensive Care Units. The outcome of such patients may be dependent on local host immune response, which may be best reflected in studies using bronchoalveolar lavage (BAL) fluid. The present study was conducted to ascertain the cytokine profile of BAL using the cytometric bead array (CBA) in a flow cytometer and to correlate the levels of Th-1/Th-2 cytokines in BAL with the clinical outcome of ventilated trauma patients.


METHODS
BAL was collected from the patients with suspected VAP. CBA was performed to assess the levels of interleukin-4 (IL-4), IL-6, IL-8, IL-1 β, interferon gamma (IFN-γ), and tumor necrosis factor-alpha in the BAL samples. After acquiring the BAL samples on the flow cytometer, the results were generated using FCAP Array™ software. The cytokine profile was correlated to clinical outcomes.


RESULTS
A total of forty patients were enrolled during the study period. Of these, 12 patients (30%) had confirmed VAP and 8 (20%) patients had a fatal outcome. The levels of IL-8 and IFN-γ correlated significantly with the development of VAP and elevated IL-6 in BAL was associated with a poor outcome.


CONCLUSIONS
A proinflammatory response in the form of elevated IL-6 and IL-8 correlated poorly with the clinical outcome. Th-1 response was significantly reduced in patients with VAP. A proinflammatory response in the form of elevated IL-6 and IL-8 correlated poorly with the clinical outcome.
Department of Surgery, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Subodh
S
Kumar
Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Nidhi
N
Bhardwaj
Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Surbhi
S
Khurana
Department of Surgery, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Amit
A
Gupta
Department of Neuroanesthesia, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Kapil Dev
KD
Soni
Department of Neuroanesthesia, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Richa
R
Aggrawal
Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Purva
P
Mathur
Bronchoalveolar lavage; cytokine bead array; prognosis; trauma; ventilator-associated pneumonia
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