Differential expression of the immunoinflammatory response in trauma patients: Burn vs. non-burn

James E. Mace, Myung S. Park, Alejandra G. Mora, Kevin K. Chung*, Wenjun Martini, Christopher E. White, John B. Holcomb, Gerald A. Merrill, Michael A. Dubick, Steven E. Wolf, Charles E. Wade, Martin G. Schwacha

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

39 Scopus citations

Abstract

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 non-burn 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.

Original languageEnglish
Pages (from-to)599-606
Number of pages8
JournalBurns
Volume38
Issue number4
DOIs
StatePublished - Jun 2012
Externally publishedYes

Keywords

  • Burn
  • Cytokine
  • Inflammation
  • Interleukin-6
  • Interleukin-8
  • Multiple
  • Trauma

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