Kinetics of plasma cytokines and its clinical significance in patients with severe trauma.

OBJECTIVE

To examine the kinetics of plasma tumor necrosis factor alpha (TNF alpha), interleukin-6 (IL-6) and interleukin-8 (IL-8) in patients with severe trauma and to discuss their relationship with organ damage and endotoxemia.

METHODS

Seventeen patients (10 men and 7 women) with severe trauma were selected in this study. Their mean age was 37.9 +/- 11.9 years. All patients were divided into two groups according to injury severity score (ISS): group I with ISS from 16-25 (18.8 +/- 2.9, n = 10) and group II with ISS more than 25 (34.3 +/- 8.3, n = 7). Ten young healthy volunteers (6 men and 4 women) were used as controls. Plasma TNF alpha and IL-8 levels were assayed with enzyme-linked immunosorbent assay. IL-6 activity in the plasma was determined by bioassay with IL-6-dependent cell-line 7TD1. Limulus amebocyte lysate chromogenic test was used for plasma endotoxin assay.

RESULTS

Plasma cytokine levels in patients with trauma had a successively significant increase. Plasma TNF level increased earlier. Increases in plasma IL-6 and IL-8 occurred later. All the increases were significantly correlated with the severity of trauma and organ damage after trauma. In addition, obvious endotoxemia occurred at the early stage of trauma and was significantly correlated with the severity of trauma and the levels of plasma TNF alpha, IL-6 and IL-8.

CONCLUSIONS

Release of TNF alpha, IL-6 and IL-8 can be significantly increased in patients with severe trauma. The increase may be related to massive endotoxin translocation and may play an important role in the development of organ damage after trauma.