Hintergrund
Polytrauma kann zu posttraumatischen Komplikationen wie „systemic inflammatory response syndrome“ (SIRS), „multi-organ dysfunktion syndrome“ (MODS) und Sepsis fuhren. Zur Zeit werden diese Komplikationen anhand klinischer und organspezifischer Parameter monitoriert. Das Immunsystem wird von dem Trauma aktiviert und Zytokine werden als Botschaftermolekule sezerniert. Sie konnen im Serum bestimmt werden und sind mit der Hohe der Inflammations- bzw. Antiinflammationsreaktion assoziiert.

Zytokine als Marker bei Polytrauma

In Polish literature, there are very little publications concentrating on the subject of using laboratory diagnostics in emergency medicine. The use of laboratory tests contributes significantly to achieving a positive result of diagnostic and therapeutic process. It the states of emergency medicine, it is particularly important to select such parameters which will have a direct impact on diagnosis or treatment. An important factor is also the time of the determinations made by the laboratory. The aim of the study is to present the basic principles of laboratory diagnosis in emergency medicine and markers, which are now rarely used, especially in highly specialized clinical and research medical centers, and in the future it may be used routinely in patient care in life-threatening condition. Anestezjologia i Ratownictwo 2014; 8: 429-436.

Diagnostyka laboratoryjna w medycynie ratunkowej - charakterystyka i możliwości Laboratory diagnostics in emergency medicine - characteristics and capabilities

AIM: To investigate posttraumatic cytokine alterations and their value for predicting complications and mortality in polytraumatized patients.

METHODS: Studies on the use of specific cytokines to predict the development of complications and mortality were identified in MEDLINE, EMBASE, Web of Science and the Cochrane Library. Of included studies, relevant data were extracted and study quality was scored.

RESULTS: Forty-two studies published between 1988 and 2015 were identified, including 28 cohort studies and 14 “nested” case-control studies. Most studies investigated the cytokines interleukin (IL)-6, IL-8, IL-10 and tumor necrosis factor (TNF-α). IL-6 seems related to muliorgan dysfunction syndrome, multiorgan failure (MOF) and mortality; IL-8 appears altered in acute respiratory distress syndrome, MOF and mortality; IL-10 alterations seem to precede sepsis and MOF; and TNF-α seems related to MOF.

CONCLUSION: Cytokine secretion patterns appear to be different for patients developing complications when compared to patients with uneventful posttraumatic course. More research is needed to strengthen the evidence for clinical relevance of these cytokines.

Predictive value of cytokines for developing complications after polytrauma

OBJECTIVE:: To define systemic release kinetics of a panel of cytokines and heat shock proteins in porcine polytrauma/hemorrhage models and to evaluate whether they could be useful as early trauma biomarkers. DESIGN AND SETTING:: Prospective study in a research laboratory. SUBJECTS:: Twenty-one Yorkshire pigs. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Pigs underwent polytrauma (femur fractures/lung contusion, P), hemorrhage (mean arterial pressure 25-30 mm Hg, H), polytrauma plus hemorrhage (P/H), or sham procedure (S). Plasma was obtained at baseline, in 5- to 15-min intervals during a 60-min shock period without intervention, and in 60- to 120-min intervals during fluid resuscitation for up to 300 min. Plasma was assayed for interleukin-1β, interleukin-4, interleukin-5, interleukin-6, interleukin-8, interleukin-10, interleukin-12/interleukin-23p40, interleukin-13, interleukin-17, interleukin-18, interferonγ, transforming growth factor-β, tumor necrosis factor-α, heat shock protein 40, heat shock protein 70, and heat shock protein 90 by enzyme-linked immunosorbent assay. All animals after S, P, and H survived (n = 5/group). Three of six animals after P/H died. Interleukin-10 increased during shock after P and this increase was attenuated after H. Tumor necrosis factor-α increased during the shock period after P, H, and also after S. P/H abolished the systemic interleukin-10 and tumor necrosis factor-α release and resulted in 20% to 30% increased levels of interleukin-6 during shock. As fluid resuscitation was initiated, tumor necrosis factor-α and interleukin-10 levels decreased after P, H, and P/H; heat shock protein 70 increased after P; and interleukin-6 levels remained elevated after P/H and also increased after P and S. CONCLUSIONS:: Differential regulation of the systemic cytokine release after polytrauma and/or hemorrhage, in combination with the effects of resuscitation, can explain the variability and inconsistent association of systemic cytokine/heat shock protein levels with clinical variables in trauma patients. Insults of major severity (P/H) partially suppress the systemic inflammatory response. The plasma concentrations of the measured cytokines/heat shock proteins do not reflect injury severity or physiological changes in porcine trauma models and are unlikely to be able to serve as useful trauma biomarkers in patients. Language: en

/pdf/systemic-release-of-cytokines-and-heat-shock-proteins-in-17bud17y0m.pdf

Systemic release of cytokines and heat shock proteins in porcine models of polytrauma and hemorrhage

Interleukin-18 (IL-18) is a pleiotropic proinflammatory cytokine with the ability to induce interferon-γ production in T-helper cells type 1 and natural killer cells. To investigate the role of IL-18 after severe trauma we measured plasma levels of IL-18 in 229 multiple injured patients [mean age of 39 ± 16 (range 11–81) years, injury severity score (ISS) of 31 ± 10 (range 16–66) points; 55 women and 174 men] and correlated these with demographics, clinical course, and routine laboratory parameters. IL-18 plasma levels were significantly increased in polytraumatized patients compared to healthy donors (p 60 years old (n = 35) had significantly lower plasma levels of IL-18 (median 45 pg/mL) compared to younger ones (n = 194, median 92 pg/mL). In the subgroup of nonsurvivors (n = 12) elderly patients had the lowest plasma levels of ...

Elevated systemic interleukin-18 in multiple injured patients is not related to clinical outcome.

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Elevated systemic interleukin-18 in multiple injured patients is not related to clinical outcome.