Qiao Zhi, Wang Weikang, Yin Luxu, Luo Peng, Greven Johannes, Horst Klemens, Hildebrand Frank
Department of Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstreet 30, 52074, Aachen, Germany.
Eur J Trauma Emerg Surg. 2018 Oct;44(5):679-687. doi: 10.1007/s00068-017-0880-9. Epub 2017 Nov 14.
In previous studies, interleukin-6 (IL-6) has been shown to have a high predictive value for the development of complications and mortality after trauma; however, there is some uncertainty around these results. The aim of this meta-analysis was to assess the value of early IL-6 levels (within the first 24 h after trauma) for predicting post-traumatic complications [acute respiratory distress syndrome (ARDS), systemic inflammatory response syndrome (SIRS), sepsis, multiple organ failure (MOF), and multiple organ dysfunction syndrome (MODS)] and mortality.
A systemic literature review (from January 01, 1990, to June 03, 2017) of English-language articles was carried out using Pubmed, the Cochrane Central Register of Controlled Trials, Embase, and Web of Science. The search terms used were IL-6 (IL6, IL-6, interleukin 6, or interleukin-6); trauma (trauma*, polytrauma*, multitrauma*, injury, or injury severity score); complications (complication*, ARDS, SIRS, sepsis, MOF, or MODS); and mortality (survival, death). Eleven publications (775 patients) out of 1812 fulfilled the criteria. Fixed-effective models were used for data analysis. Statistical heterogeneity was estimated by a Chi-squared Q test and I statistics, and publication bias was assessed with Egger's test.
Results showed that the concentrations of IL-6 within the first 24 h after trauma were significantly higher in the group of patients who had complications or who died [standardized mean difference (SMD) = 0.399; 95% confidence interval (CI) 0.217, 0.580; I = 0.0%; P(heterogeneity) = 0.489]. Subgroup results showed a significant correlation for mortality [SMD = 0.610; 95% CI 0.322, 0.898; I = 0.0%; P(heterogeneity) = 0.708] and MOF/MODS [SMD = 0.334; 95% CI 0.028, 0.639; I = 0.0%; P(heterogeneity) = 0.512] with IL-6, but not for sepsis [SMD = 0.194; 95% CI - 0.095, 0.484; I = 0.0%; P(heterogeneity) = 0.512]. Significance was also found in both ISS ≥ 9 [SMD = 0.461, 95% CI 0.131, 0.791, I = 5.6%, P(heterogeneity) = 0.365] and ISS ≥ 16 [SMD = 0.372, 95% CI 0.155, 0.588, I = 1.5%, P(heterogeneity) = 0.413].
In conclusion, this meta-analysis showed that serum concentration of IL-6 within the first 24 h after trauma could be useful for the prediction of post-traumatic complications, particularly MOF/MODS and mortality.
在先前的研究中，白细胞介素-6（IL-6）已被证明对创伤后并发症的发生和死亡率具有较高的预测价值；然而，这些结果存在一些不确定性。本荟萃分析的目的是评估创伤后早期（创伤后24小时内）IL-6水平对预测创伤后并发症[急性呼吸窘迫综合征（ARDS）、全身炎症反应综合征（SIRS）、脓毒症、多器官功能衰竭（MOF）和多器官功能障碍综合征（MODS）]及死亡率的价值。
使用PubMed、Cochrane对照试验中央注册库、Embase和科学网对1990年1月1日至2017年6月3日发表的英文文章进行系统文献综述。使用的检索词为IL-6（IL6、IL-6、白细胞介素6或interleukin-6）；创伤（trauma*、polytrauma*、multitrauma*、injury或injury severity score）；并发症（complication*、ARDS、SIRS、脓毒症、MOF或MODS）；以及死亡率（survival、death）。1812篇文献中有11篇（775例患者）符合标准。采用固定效应模型进行数据分析。通过卡方Q检验和I²统计量估计统计异质性，并用Egger检验评估发表偏倚。
结果显示，发生并发症或死亡的患者组在创伤后24小时内IL-6浓度显著更高[标准化平均差（SMD）=0.399；95%置信区间（CI）0.217，0.580；I²=0.0%；P（异质性）=0.489]。亚组结果显示，死亡率[SMD=0.610；95%CI 0.322，0.898；I²=0.0%；P（异质性）=0.708]和MOF/MODS[SMD=0.334；95%CI 0.028，0.639；I²=0.0%；P（异质性）=0.512]与IL-6存在显著相关性，但脓毒症无相关性[SMD=0.194；95%CI -0.095，0.484；I²=0.0%；P（异质性）=0.512]。在损伤严重度评分（ISS）≥9[SMD=0.461，95%CI 0.131，0.791，I²=5.6%，P（异质性）=0.365]和ISS≥16[SMD=0.372，95%CI 0.155，0.588，I²=1.5%，P（异质性）=0.413]时也发现了显著性。
总之，本荟萃分析表明，创伤后24小时内血清IL-6浓度可用于预测创伤后并发症，尤其是MOF/MODS和死亡率。
