Differential expression of the immunoinflammatory response in trauma patients: burn vs. non-burn.

Abstract

RATIONALE:

Cytokines are central mediators of the immune-inflammatory response to injury and subsequent multiple organ dysfunction syndrome (MODS). Although previous studies evaluated cytokine levels after trauma, differences between patients with burn and non-burn trauma have not been assessed systematically.

METHODS:

A prospective database of trauma patients admitted between May 2004 and September 2007 to the burn or surgical intensive care units within 24 h of injury with an anticipated stay of at least 72 h was analyzed. Sequential clinical and laboratory parameters were collected in the first week, including multiplex analysis data for plasma levels of inflammatory cytokines (IL-6, and IL-8). Patients with known pre-injury coagulopathy were excluded. A Marshall score of 10 or greater was defined as MODS.

RESULTS:

A total of 179 patients were enrolled (67 burn and 112 non-burn). Plasma IL-6 and IL-8 levels were markedly elevated in both burn and non-burn patients compared to healthy volunteers. Burn subjects had higher levels of IL-6 and IL-8 than the non-burn on days 1 through 7 after injury. Subjects with burns and at least 30% total body surface area were older and had a lower injury severity score, a higher prevalence of MODS, and correspondingly higher mortality. Multivariate analysis of injury type, MODS, and time did not demonstrate an influence of MODS.

CONCLUSIONS:

Burns were associated with a greater and more sustained immune-inflammatory response than non-burn trauma as evidenced by elevated plasma IL-6 and IL-8 levels during the first week. There was no association between MODS and plasma cytokine levels.

• Authors: James E Mace, Myung S Park, Alejandra G Mora, Kevin K Chung, Wenjun Martini, Christopher E White, John B Holcomb, Gerald A Merrill, Michael A Dubick, Steven E Wolf, Charles E Wade, Martin G Schwacha
• Journal: Burns : journal of the International Society for Burn Injuries (Burns) Vol. 38 Issue 4 Pg. 599-606 (Jun 2012) ISSN: 1879-1409 [Electronic] Netherlands
• PMID: 22103986 (Publication Type: Journal Article)
• Copyright: Published by Elsevier Ltd.

Chemical References

• Interleukin-6
• Interleukin-8

Topics

• Adult
• Burns (complications, immunology)
• Female
• Humans
• Interleukin-6 (metabolism)
• Interleukin-8 (metabolism)
• Male
• Middle Aged
• Multiple Organ Failure (etiology, immunology)
• Multivariate Analysis
• Prospective Studies
• Systemic Inflammatory Response Syndrome (immunology)
• Wounds and Injuries (immunology)