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Disease Markers
Volume 2015, Article ID 747036, 8 pages
http://dx.doi.org/10.1155/2015/747036
Research Article

Measurement of Cytokines and Adhesion Molecules in the First 72 Hours after Severe Trauma: Association with Severity and Outcome

1Centro Hospitalar de São João (CHSJ), Porto, Portugal
2Orthopaedic Department and Emergency and Intensive Care Department, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal
3CHSJ, Orthopaedic Department and Emergency and Intensive Care Department, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal
4CHSJ, Anesthesiology Department, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal
5CHSJ, Orthopaedic Department, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal
6Centro Hospitalar São João, Orthopaedic Department, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal
7Centro Hospitalar de São João, Clinical Pathology Department, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal
8Emergency and Intensive Care Department, Centro Hospitalar Sao Joao, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal
9Faculty of Medicine, University of Porto, Portugal

Received 5 January 2015; Revised 24 February 2015; Accepted 24 February 2015

Academic Editor: Natacha Turck

Copyright © 2015 António Sousa et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Severity and outcome assessments are crucial in trauma. Our aim was to describe the role of a group of cytokines (TNFα, IL-6, IL-10, and HMGB-1) and ICAM-1 as severity and outcome assessment tools and their kinetics in the first 72 h after severe trauma. Materials and Methods. Authors designed a prospective cohort study of severe polytrauma patients (ISS > 15) in a level 1 Trauma Centre. Cytokines and ICAM-1 levels and Th1/Th2 ratios were assessed at admission, 24, 48, and 72 h. SIRS, SIRS with hypoperfusion, and shock were identified. Outcomes considered were ICU admission, ARDS, MODS, and death. Results. Ninety-nine patients were enrolled (median ISS: 29 and age 31). There was an early release of pro- and anti-inflammatory mediators with higher values at admission (except for ICAM-1). On admission, IL-6 was associated with ISS, IL-10 with SIRS with hypoperfusion, and HMGB-1 with shock. Several cytokines were associated with outcomes, especially IL-6 and IL-10 at 72 h with MODS and death. Low TNFα/IL-10 and IL-6/IL-10 ratios at 24 and 72 h were associated with MODS and death. Conclusions. Pro- and anti-inflammatory responses occur simultaneously and earlier after injury. Cytokines may be useful for outcome assessment, especially IL-6 and IL-10. Low Th1/Th2 ratio at 24 to 72 h is associated with MODS and death.