Trauma Department, Hannover Medical School, Hannover, Germany.
Scand J Trauma Resusc Emerg Med. 2009 Sep 27;17:49. doi: 10.1186/1757-7241-17-49.
Although therapeutic concepts of patients with major trauma have improved during recent years, organ dysfunction still remains a frequent complication during clinical course in intensive care units. It has previously been shown that cytokines are upregulated under stress conditions such as trauma or sepsis. However, it is still debatable if cytokines are adequate parameters to describe the current state of trauma patients. To elucidate the relevance of cytokines, we investigated if cytokines predict development of multiple organ dysfunction syndrome (MODS) or outcome.
A total of 143 patients with an injury severity score >or= 16, between 16 and 65 years, admitted to the Hannover Medical School Level 1 Trauma Center between January 1997 and December 2001 were prospectively included in this study. Marshall Score for MODS was calculated for at least 14 days and plasma levels of TNF-alpha, IL-1beta, IL-6, IL-8 and IL-10 were measured. To determine the association between cytokine levels and development of MODS the Spearman rank correlation coefficient was calculated and logistic regression and analysis were performed.
Patients with MODS had increased plasma levels of IL-6, IL-8 and IL-10. IL-6 predicted development of MODS with an overall accuracy of 84.7% (specificity: 98.3%, sensitivity: 16.7%). The threshold value for development of MODS was 761.7 pg/ml and 2176.0 pg/ml for mortality during the in patient time.
We conclude that plasma IL-6 levels predict mortality and that they are a useful tool to identify patients who are at risk for development of MODS.
尽管近年来严重创伤患者的治疗理念有所改善，但在重症监护病房的临床过程中，器官功能障碍仍然是一种常见的并发症。以前已经表明，细胞因子在创伤或败血症等应激条件下会被上调。然而，细胞因子是否是描述创伤患者当前状态的合适参数仍存在争议。为了阐明细胞因子的相关性，我们研究了细胞因子是否可以预测多器官功能障碍综合征（MODS）的发生或预后。
本研究前瞻性纳入了 1997 年 1 月至 2001 年 12 月期间，在汉诺威医学院 1 级创伤中心收治的损伤严重程度评分≥16 分，年龄在 16-65 岁之间的 143 例患者。至少 14 天计算马歇尔 MODS 评分，并测量 TNF-α、IL-1β、IL-6、IL-8 和 IL-10 的血浆水平。为了确定细胞因子水平与 MODS 发生之间的关联，计算了 Spearman 秩相关系数，并进行了逻辑回归和分析。
MODS 患者的 IL-6、IL-8 和 IL-10 血浆水平升高。IL-6 对 MODS 的发生具有预测作用，总准确率为 84.7%（特异性：98.3%，敏感性：16.7%）。MODS 发生的阈值为 761.7 pg/ml，住院期间死亡率的阈值为 2176.0 pg/ml。
我们得出结论，血浆 IL-6 水平可以预测死亡率，是识别发生 MODS 风险患者的有用工具。
