University Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
World J Emerg Surg. 2019 Jul 19;14:36. doi: 10.1186/s13017-019-0256-z. eCollection 2019.
According to recently published findings, we hypothesized that serum interleukin-33 (IL-33) may qualify for predicting pulmonary complications in polytraumatized patients.
One hundred and thirty patients (age ≥ 18 years, ISS ≥ 16) were included in our prospective analysis after primary admission to our level I trauma center during the first post-traumatic hour. Serum samples immediately after admission and on day 2 after trauma were obtained and analyzed.
Median initial IL-33 levels (in picograms per milliliter) were higher in polytrauma victims (1) with concomitant thoracic trauma [5.08 vs. 3.52; = 0.036], (2) sustaining parenchymal lung injury (PLI) [5.37 vs. 3.71; = 0.027], and (3) developing acute respiratory distress syndrome (ARDS) [6.19 vs. 4.48; = 0.003], compared to the respective rest of the study group. The median initial IL-33 levels were higher in patients experiencing both PLI and ARDS compared to those sustaining PLI and not developing ARDS [6.99 vs. 4.69; = 0.029]. ROC statistics provided an AUC of 0.666 ( = 0.003) and a cut-off value of 4.77 (sensitivity, 71.8%; specificity, 75.7%) for predicting ARDS. Moreover, a higher initial median IL-33 level was revealed in the deceased compared to the survivors [12.25 vs. 4.72; = 0.021]. ROC statistics identified the initial level of IL-33 as a predictor of death with 11.19 as cut-off value (sensitivity, 80.0%; specificity, 80.0%; AUC = 0.805; = 0.021).
Following tissue damage, IL-33 is abundantly released in the serum of polytraumatized patients immediately after their injuries occurred. As initial IL-33 levels were particularly high in individuals experiencing both PLI and ARDS, IL-33 release after trauma seems to be involved in the promotion of ARDS and might serve already at admission as a solid indicator of impending death in polytraumatized patients.
根据最近发表的研究结果，我们假设血清白细胞介素-33（IL-33）可能有资格预测多发伤患者的肺部并发症。
在创伤后第一个小时内，我们对我院 I 级创伤中心初次入院的 130 名年龄≥18 岁、ISS≥16 的患者进行了前瞻性分析。入院时和创伤后第 2 天立即采集血清样本并进行分析。
多发伤患者（1）合并胸部创伤[5.08 比 3.52；=0.036]，（2）发生实质肺损伤（PLI）[5.37 比 3.71；=0.027]，（3）发生急性呼吸窘迫综合征（ARDS）[6.19 比 4.48；=0.003]的初始 IL-33 中位数水平较高。与研究组其余部分相比。与仅发生 PLI 而未发生 ARDS 的患者相比，同时发生 PLI 和 ARDS 的患者的初始 IL-33 中位数水平更高[6.99 比 4.69；=0.029]。ROC 统计提供了 0.666（=0.003）的 AUC 和 4.77（灵敏度，71.8%；特异性，75.7%）的截断值，用于预测 ARDS。此外，死亡患者的初始 IL-33 中位数水平高于存活患者[12.25 比 4.72；=0.021]。ROC 统计确定初始 IL-33 水平是死亡的预测因子，截断值为 11.19（灵敏度，80.0%；特异性，80.0%；AUC=0.805；=0.021）。
在组织损伤后，IL-33 会在多发伤患者受伤后立即大量释放到血清中。由于 PLI 和 ARDS 患者的初始 IL-33 水平特别高，创伤后 IL-33 的释放似乎参与了 ARDS 的发生，并可能在入院时作为多发伤患者即将死亡的可靠指标。
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