Differential Expression of the Immunoinflammatory Response in Trauma Patients: Burn vs. Non-Burn
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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Rationale Cytokines are central mediators of the immune-inflammatory response to injury and subsequent multiple organ dysfunction syndrome MODS. Although previous studies evaluated cytokine levels after trauma, differences between patients with burn and nonburn trauma have not been assessed systematically. Methods A prospective database of trauma patients admitted between May 2004 and September 2007 to the burn or surgical intensive care units within 24 h of injury with an anticipated stay of at least 72 h was analyzed. Sequential clinical and laboratory parameters were collected in the first week, including multiplex analysis data for plasma levels of inflammatory cytokines IL-6, and IL-8. Patients with known pre-injury coagulopathy were excluded. A Marshall score of 10 or greater was defined as MODS. Results A total of 179 patients were enrolled 67 burn and 112 non-burn. Plasma IL-6 and IL- 8 levels were markedly elevated in both burn and non-burn patients compared to healthy volunteers. Burn subjects had higher levels of IL-6 and IL-8 than the non-burn on days 1 through 7 after injury. Subjects with burns and at least 30 total body surface area were older and had a lower injury severity score, a higher prevalence of MODS, and correspondingly higher mortality. Multivariate analysis of injury type, MODS, and time did not demonstrate an influence of MODS. Conclusions Burns were associated with a greater and more sustained immune-inflammatory response than non-burn trauma as evidenced by elevated plasma IL-6 and IL-8 levels during the first week. There was no association between MODS and plasma cytokine levels.
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