Early Cytokine Production Risk Stratifies Trauma Patients for Multiple Organ Failure

Kenneth M. Jastrow, Ernest A. Gonzalez, Mary F. McGuire, James W. Suliburk, Rosemary A. Kozar, Sriram Iyengar, Deborah A. Motschall, Bruce A. McKinley, Frederick A. Moore, David W. Mercer

Research output: Contribution to journalArticle

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Abstract

Background: Shock is a prime inciting event for postinjury multiple organ failure (MOF), believed to induce a state of injurious systemic inflammation. In animal models of hemorrhagic shock, early (< 24 hours) changes in cytokine production are an index of the systemic inflammatory response syndrome. However, their predictive value in trauma patients remains to be fully elucidated. Study Design: In a prospective observational pilot study of > 1 year at an urban Level I trauma center, serial (every 4 hours) serum cytokine levels were determined during a 24-hour period using multiplex suspension immunoassay in patients with major torso trauma (excluding severe brain injury) who met criteria for standardized shock resuscitation. Temporal cytokine expression was assessed during shock resuscitation in severe trauma patients to predict risk for MOF. MOF was assessed with the Denver score. Results: Of 48 study patients (mean age 39 ± 3 years, 67% men, 88% blunt mechanism, mean Injury Severity Score 25 ± 2), MOF developed in 11 (23%). MOF patients had a considerably higher mortality (64% versus 3%) and fewer ICU-free days (3.5 ± 2 versus 17.8 ± 1.3 days) compared with non-MOF patients. Traditional predictors of MOF, including age (45 ± 7 versus 38 ± 3 years; p=0.21), Injury Severity Score (26 ± 3 versus 25 ± 2; p=0.67), admission hemoglobin (11.4 ± 0.9 versus 12.1 ± 0.5 g/dL; p=0.22), international normalized ratio (1.6 ± 0.2 versus 1.4 ± 0.06; p=0.17), and base deficit (9.0 ± 2 versus 7.1 ± 0.8; p=0.19), were not significantly different between MOF and non-MOF patients. Statistical analysis identified six candidate predictors of MOF: inducible protein 10, macrophage inflammatory protein-1β, interleukin-10, interleukin-6, interleukin-1Ra, and eotaxin. Conclusions: These data provide insight into cytokine expression during traumatic shock that can enable earlier identification of patients at risk for development of MOF.

Original languageEnglish (US)
Pages (from-to)320-331
Number of pages12
JournalJournal of the American College of Surgeons
Volume209
Issue number3
DOIs
StatePublished - Sep 1 2009

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Multiple Organ Failure
Cytokines
Wounds and Injuries
Shock
Injury Severity Score
Resuscitation
Traumatic Shock
Macrophage Inflammatory Proteins
Torso
International Normalized Ratio
Hemorrhagic Shock
Trauma Centers
Interleukins
Immunoassay
Interleukin-10
Brain Injuries
Interleukin-6
Suspensions
Hemoglobins
Animal Models

ASJC Scopus subject areas

  • Surgery

Cite this

Early Cytokine Production Risk Stratifies Trauma Patients for Multiple Organ Failure. / Jastrow, Kenneth M.; Gonzalez, Ernest A.; McGuire, Mary F.; Suliburk, James W.; Kozar, Rosemary A.; Iyengar, Sriram; Motschall, Deborah A.; McKinley, Bruce A.; Moore, Frederick A.; Mercer, David W.

In: Journal of the American College of Surgeons, Vol. 209, No. 3, 01.09.2009, p. 320-331.

Research output: Contribution to journalArticle

Jastrow, KM, Gonzalez, EA, McGuire, MF, Suliburk, JW, Kozar, RA, Iyengar, S, Motschall, DA, McKinley, BA, Moore, FA & Mercer, DW 2009, 'Early Cytokine Production Risk Stratifies Trauma Patients for Multiple Organ Failure', Journal of the American College of Surgeons, vol. 209, no. 3, pp. 320-331. https://doi.org/10.1016/j.jamcollsurg.2009.05.002
Jastrow, Kenneth M. ; Gonzalez, Ernest A. ; McGuire, Mary F. ; Suliburk, James W. ; Kozar, Rosemary A. ; Iyengar, Sriram ; Motschall, Deborah A. ; McKinley, Bruce A. ; Moore, Frederick A. ; Mercer, David W. / Early Cytokine Production Risk Stratifies Trauma Patients for Multiple Organ Failure. In: Journal of the American College of Surgeons. 2009 ; Vol. 209, No. 3. pp. 320-331.
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abstract = "Background: Shock is a prime inciting event for postinjury multiple organ failure (MOF), believed to induce a state of injurious systemic inflammation. In animal models of hemorrhagic shock, early (< 24 hours) changes in cytokine production are an index of the systemic inflammatory response syndrome. However, their predictive value in trauma patients remains to be fully elucidated. Study Design: In a prospective observational pilot study of > 1 year at an urban Level I trauma center, serial (every 4 hours) serum cytokine levels were determined during a 24-hour period using multiplex suspension immunoassay in patients with major torso trauma (excluding severe brain injury) who met criteria for standardized shock resuscitation. Temporal cytokine expression was assessed during shock resuscitation in severe trauma patients to predict risk for MOF. MOF was assessed with the Denver score. Results: Of 48 study patients (mean age 39 ± 3 years, 67{\%} men, 88{\%} blunt mechanism, mean Injury Severity Score 25 ± 2), MOF developed in 11 (23{\%}). MOF patients had a considerably higher mortality (64{\%} versus 3{\%}) and fewer ICU-free days (3.5 ± 2 versus 17.8 ± 1.3 days) compared with non-MOF patients. Traditional predictors of MOF, including age (45 ± 7 versus 38 ± 3 years; p=0.21), Injury Severity Score (26 ± 3 versus 25 ± 2; p=0.67), admission hemoglobin (11.4 ± 0.9 versus 12.1 ± 0.5 g/dL; p=0.22), international normalized ratio (1.6 ± 0.2 versus 1.4 ± 0.06; p=0.17), and base deficit (9.0 ± 2 versus 7.1 ± 0.8; p=0.19), were not significantly different between MOF and non-MOF patients. Statistical analysis identified six candidate predictors of MOF: inducible protein 10, macrophage inflammatory protein-1β, interleukin-10, interleukin-6, interleukin-1Ra, and eotaxin. Conclusions: These data provide insight into cytokine expression during traumatic shock that can enable earlier identification of patients at risk for development of MOF.",
author = "Jastrow, {Kenneth M.} and Gonzalez, {Ernest A.} and McGuire, {Mary F.} and Suliburk, {James W.} and Kozar, {Rosemary A.} and Sriram Iyengar and Motschall, {Deborah A.} and McKinley, {Bruce A.} and Moore, {Frederick A.} and Mercer, {David W.}",
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AU - Jastrow, Kenneth M.

AU - Gonzalez, Ernest A.

AU - McGuire, Mary F.

AU - Suliburk, James W.

AU - Kozar, Rosemary A.

AU - Iyengar, Sriram

AU - Motschall, Deborah A.

AU - McKinley, Bruce A.

AU - Moore, Frederick A.

AU - Mercer, David W.

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N2 - Background: Shock is a prime inciting event for postinjury multiple organ failure (MOF), believed to induce a state of injurious systemic inflammation. In animal models of hemorrhagic shock, early (< 24 hours) changes in cytokine production are an index of the systemic inflammatory response syndrome. However, their predictive value in trauma patients remains to be fully elucidated. Study Design: In a prospective observational pilot study of > 1 year at an urban Level I trauma center, serial (every 4 hours) serum cytokine levels were determined during a 24-hour period using multiplex suspension immunoassay in patients with major torso trauma (excluding severe brain injury) who met criteria for standardized shock resuscitation. Temporal cytokine expression was assessed during shock resuscitation in severe trauma patients to predict risk for MOF. MOF was assessed with the Denver score. Results: Of 48 study patients (mean age 39 ± 3 years, 67% men, 88% blunt mechanism, mean Injury Severity Score 25 ± 2), MOF developed in 11 (23%). MOF patients had a considerably higher mortality (64% versus 3%) and fewer ICU-free days (3.5 ± 2 versus 17.8 ± 1.3 days) compared with non-MOF patients. Traditional predictors of MOF, including age (45 ± 7 versus 38 ± 3 years; p=0.21), Injury Severity Score (26 ± 3 versus 25 ± 2; p=0.67), admission hemoglobin (11.4 ± 0.9 versus 12.1 ± 0.5 g/dL; p=0.22), international normalized ratio (1.6 ± 0.2 versus 1.4 ± 0.06; p=0.17), and base deficit (9.0 ± 2 versus 7.1 ± 0.8; p=0.19), were not significantly different between MOF and non-MOF patients. Statistical analysis identified six candidate predictors of MOF: inducible protein 10, macrophage inflammatory protein-1β, interleukin-10, interleukin-6, interleukin-1Ra, and eotaxin. Conclusions: These data provide insight into cytokine expression during traumatic shock that can enable earlier identification of patients at risk for development of MOF.

AB - Background: Shock is a prime inciting event for postinjury multiple organ failure (MOF), believed to induce a state of injurious systemic inflammation. In animal models of hemorrhagic shock, early (< 24 hours) changes in cytokine production are an index of the systemic inflammatory response syndrome. However, their predictive value in trauma patients remains to be fully elucidated. Study Design: In a prospective observational pilot study of > 1 year at an urban Level I trauma center, serial (every 4 hours) serum cytokine levels were determined during a 24-hour period using multiplex suspension immunoassay in patients with major torso trauma (excluding severe brain injury) who met criteria for standardized shock resuscitation. Temporal cytokine expression was assessed during shock resuscitation in severe trauma patients to predict risk for MOF. MOF was assessed with the Denver score. Results: Of 48 study patients (mean age 39 ± 3 years, 67% men, 88% blunt mechanism, mean Injury Severity Score 25 ± 2), MOF developed in 11 (23%). MOF patients had a considerably higher mortality (64% versus 3%) and fewer ICU-free days (3.5 ± 2 versus 17.8 ± 1.3 days) compared with non-MOF patients. Traditional predictors of MOF, including age (45 ± 7 versus 38 ± 3 years; p=0.21), Injury Severity Score (26 ± 3 versus 25 ± 2; p=0.67), admission hemoglobin (11.4 ± 0.9 versus 12.1 ± 0.5 g/dL; p=0.22), international normalized ratio (1.6 ± 0.2 versus 1.4 ± 0.06; p=0.17), and base deficit (9.0 ± 2 versus 7.1 ± 0.8; p=0.19), were not significantly different between MOF and non-MOF patients. Statistical analysis identified six candidate predictors of MOF: inducible protein 10, macrophage inflammatory protein-1β, interleukin-10, interleukin-6, interleukin-1Ra, and eotaxin. Conclusions: These data provide insight into cytokine expression during traumatic shock that can enable earlier identification of patients at risk for development of MOF.

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