Early inflammatory response in polytraumatized patients: Cytokines and heat shock proteins. A pilot study - 03/09/15
, A. Ortiz b, F. Chana b, c, B. Alonso b, J. Vaquero b, c
Bienvenido a EM-consulte, la referencia de los profesionales de la salud.
Artículo gratuito.
Conéctese para beneficiarse!
Abstract |
Introduction |
In the initial phases after polytrauma there is an hyperinflammatory state that sometimes leads to multiple organ dysfunction syndrome (MODS) and death, and that appears to be responsible for posttraumatic immunosuppression; among the trigger endogenous stimuli, heat shock proteins (HSPs) have been proposed. The objectives of this study were to analyze if some inflammatory mediators can be considered prognostic biomarkers of outcome, and the possible role of HSPA1A in posttraumatic immunosuppression.
Hypothesis |
Cytokines and HSPs could be early prognostic biomarkers of inflammatory and immune response in polytrauma patients.
Materials and methods |
A prospective observational descriptive pilot study was carried out, evaluating the early inflammatory and stress response of 18 polytraumatized patients (ISS>16) on hospital admission, at 12hours, 24hours, and 48hours posttrauma. Variable means were compared using non-parametric tests; qualitative and quantitative variables were analyzed using a Spearman's correlation test.
Results |
Seven patients met criteria for MODS. Statistically significant changes were recorded in leukocyte count, C-reactive-protein (CRP), IL-6, TNF-α, and IL-1ß concentrations. HSPA1A levels were significantly higher immediately after the accident followed by gradual lowering. Anti-Hsp70 antibodies showed a significant reduction in all the studied time-points. MODS did not influence either plasma levels of leukocytes, fibrinogen, RCP or anti-Hsp70, but patients with MODS had higher plasma levels of IL-6 and TNF-α and a slower decrease of HSPA1A concentrations.
Discussion |
The higher serum concentrations of TNF-α and IL-6 found in patients with MODS, suggests a possible role as potential early predictive markers for systemic inflammatory response and clinical complications. The higher levels of HSPA1A in patients with MODS, allows proposing HSPA1A as a useful prognostic trauma biomarker early after severe injury and to consider a “damage control surgery”. The significant reduction in the levels of anti-Hsp70 antibodies could reflect a part of posttraumatic immunosuppression and hydrocortisone treatment might be suggested.
Level of evidence |
Level III: case-control study.
El texto completo de este artículo está disponible en PDF.Keywords : Polytrauma, Inflammatory response, Posttraumatic immunosuppresion, Cytokines, Heat shock proteins
Esquema
Vol 101 - N° 5
P. 607-611 - septembre 2015 Regresar al número
Artículo precedente
- Tissue engineering strategy using mesenchymal stem cell-based chitosan scafolds in growth plate surgery: A preliminary study in rabbits
- M.R. Azarpira, G.H. Shahcheraghi, M. Ayatollahi, B. Geramizadeh
- Clinical and stereoradiographic analysis of adult spinal deformity with and without rotatory subluxation
- E. Ferrero, R. Lafage, V. Challier, B. Diebo, P. Guigui, K. Mazda, F. Schwab, W. Skalli, V. Lafage
Bienvenido a EM-consulte, la referencia de los profesionales de la salud.