Abstract
ObjectiveMajor trauma is characterized by a pro-inflammatory response, followed by an immunosuppression. Recently, in trauma patients, the lack of recovery of monocyte Human Leukocyte Antigen DR (mHLA-DR, a biomarker of ICU-acquired immunosuppression) between days 1–2 and days 3–4 has been demonstrated to be independently associated with sepsis development. The main objective of this study was to determine whether early measurements of IL-6 (interleukin-6) and IL-10 plasma concentrations (as markers of initial severity) could improve, in association with mHLA-DR recovery, the prediction of sepsis occurrence in severe trauma patients.DesignProspective observational study over 24 months in a Trauma ICU at university hospital.PatientsTrauma patients with an ISS over 25 and age over 18 were included.Measurements and Main ResultsmHLA-DR was assessed by flow cytometry, IL-6 and IL-10 concentrations by ELISA. 100 consecutive severely injured patients were monitored (mean ISS 37±10). 37 patients developed sepsis. IL-6 concentrations and slope of mHLA-DR expression between days 1–2 and days 3–4 were significantly different between septic and non-septic patients. IL-10 was not detectable in most patients. After adjustment for usual clinical confounders, when assessed as a pair, multivariate logistic regression analysis revealed that a slope of mHLA-DR expression (days 3–4/days 1–2)≤1.1 and a IL-6 concentration ≥ 67.1 pg/ml remained highly associated with the development of sepsis (adjusted OR 18.4, 95% CI 4.9; 69.4, p = .00002).ConclusionsAfter multivariate regression logistic analysis, when assessed as a pair, a high IL-6 concentration and a persistent mHLA-DR decreased expression were found to be in relation with the development of sepsis with the best predictive value. This study underlines the usefulness of daily monitoring of immune function to identify trauma patients at a high risk of infection.
Highlights
Severe injuries induce a systemic inflammatory response that may be followed by an anti-inflammatory response [1], which contributes to a state of transient immunosuppression [2,3,4]
After multivariate regression logistic analysis, when assessed as a pair, a high IL-6 concentration and a persistent mHLA-DR decreased expression were found to be in relation with the development of sepsis with the best predictive value
This study underlines the usefulness of daily monitoring of immune function to identify trauma patients at a high risk of infection
Summary
Severe injuries induce a systemic inflammatory response that may be followed by an anti-inflammatory response [1], which contributes to a state of transient immunosuppression [2,3,4]. The latter is believed to be directly responsible for a detrimental outcome in trauma patients and for lowering the resistance to nosocomial infections in patients who have survived initial resuscitation [5,6,7]. A decreased in mHLA-DR expression has been shown in severely injured trauma patients. As immunosuppression is hypothesized to be proportional to the intensity of initial tremendous inflammation, we reasoned that cumulative information from both initial cytokine response and delayed evolution of mHLA-DR may provide improved information regarding the risk of secondary infection development
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