Cytokines Involved in Trauma Death

A new study indicates that cytokine levels reflect severity of injury and that death in severe trauma may be the result of an exhausted cytokine response.

Researchers at Copenhagen University Hospital (Denmark) performed a study of 265 consecutive adult trauma patients admitted directly from the trauma scene. Patients were admitted between 2003 and 2004, and the length of the subsequent observation period was 18 months. The researchers serially measured levels of interleukin-6 (IL-6), a pro-inflammatory cytokine, and IL-10, an anti-inflammatory cytokine. The first sample was taken within 40 minutes of the accident; successive samples were taken at six, 12, and 24 hours after the trauma.

The researchers found that there was an almost immediate release of IL-6 and IL-10, and that the injury severity score was significantly correlated with IL-6 and IL-10 levels at all time points. At 30 days after the trauma, the mortality rate was 10.9%. The results of the study were reported at the 36th Critical Care Congress of the Society of Critical Care Medicine, held during February 2007 in Orlando (FL, USA).

"Nonsurvivors had the highest scores. IL-6 scores were four times higher than baseline and IL-10 levels were 10 times higher than baseline at the time of death,” said lead author Jakob Stensballe, M.D., Ph.D., of the department of anesthesia. "Death could be the result of an exhausted IL-10 response. The body doesn't have the ability to prioritize its response to inflammation after a certain point. This is a part of a cytokine storm that happens in trauma.”

The researchers suggested that a clinical implication of the study might be to stimulate the IL-10 response by giving corticosteroids to improve survival, and suggested that a randomized trial of corticosteroids and IL-10 response might offer insight into the treatment of acute trauma patients.


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