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Zytokine als Marker bei Polytrauma

Cytokines as biomarkers in polytraumatized patients

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Zusammenfassung

Hintergrund

Polytrauma kann zu posttraumatischen Komplikationen wie „systemic inflammatory response syndrome“ (SIRS), „multi-organ dysfunktion syndrome“ (MODS) und Sepsis führen. Zur Zeit werden diese Komplikationen anhand klinischer und organspezifischer Parameter monitoriert. Das Immunsystem wird von dem Trauma aktiviert und Zytokine werden als Botschaftermoleküle sezerniert. Sie können im Serum bestimmt werden und sind mit der Höhe der Inflammations- bzw. Antiinflammationsreaktion assoziiert.

Ziel

Dieses Review beschreibt klinische Arbeiten, in denen Zytokine wie TNF-α, IL-1β, IL-6, IL-8 und IL-10 gemessen wurden um posttraumatische Komplikationen zu prognostizieren. Andererseits kann IL-6 bei der Entscheidung für die Art der Primäroperation hilfreich sein (Fixateur externe oder Marknagelung). Des Weiteren kann anhand von IL-6 die Stärke der Immunreaktion und somit der Zeitpunkt für die Sekundäroperation bestimmt werden.

Abstract

Background

Multiple trauma can lead to posttraumatic complications such as systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS), and sepsis. Currently, these complications are monitored using clinical and organ-specific parameters. The immune system is activated by trauma. Cytokines, which are the messenger molecules of this system, can be determined in serum. Furthermore, they are associated with the intensity of the inflammatory and anti-inflammatory reactions.

Aim

This review describes clinical studies that measured cytokines such as TNF-α, IL-1β, IL-6, IL-8, and IL-10 to prognosticate posttraumatic complications. On the other hand, IL-6 can be helpful in deciding which primary operation to perform, i.e., external fixator or intramedullary nail. Moreover, IL-6 indicates the strength of the immune reaction. Thereby, it may help in determining the optimal time for secondary surgery.

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Literatur

  1. Billeter A, Turina M, Seifert B et al (2009) Early serum procalcitonin, interleukin-6, and 24-hour lactate clearance: useful indicators of septic infections in severely traumatized patients. World J Surg 33:558–566

    Article  PubMed  Google Scholar 

  2. Bogner V, Keil L, Kanz KG et al (2009) Very early posttraumatic serum alterations are significantly associated to initial massive RBC substitution, injury severity, multiple organ failure and adverse clinical outcome in multiple injured patients. Eur J Med Res 14:284–291

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Bone RC (1996) Immunologic dissonance: a continuing evolution in our understanding of the systemic inflammatory response syndrome (SIRS) and the multiple organ dysfunction syndrome (MODS). Ann Intern Med 125:680–687

    Article  CAS  PubMed  Google Scholar 

  4. Choudhry MA, Bland KI, Chaudry IH (2007) Trauma and immune response – effect of gender differences. Injury 38:1382–1391

    Article  PubMed Central  PubMed  Google Scholar 

  5. Cuschieri J, Bulger E, Schaeffer V et al (2010) Early elevation in random plasma IL-6 after severe injury is associated with development of organ failure. Shock 34:346–351

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Ertel W, Kremer JP, Kenney J et al (1995) Downregulation of proinflammatory cytokine release in whole blood from septic patients. Blood 85:1341–1347

    CAS  PubMed  Google Scholar 

  7. Foex BA, Lamb WR, Roberts TE et al (1993) Early cytokine response to multiple injury. Injury 24:373–376

    Article  CAS  PubMed  Google Scholar 

  8. Frink M, Pape HC, Van Griensven M et al (2007) Influence of sex and age on mods and cytokines after multiple injuries. Shock 27:151–156

    Article  CAS  PubMed  Google Scholar 

  9. Frink M, Van Griensven M, Kobbe P et al (2009) IL-6 predicts organ dysfunction and mortality in patients with multiple injuries. Scand J Trauma Resusc Emerg Med 17:49

    Article  PubMed Central  PubMed  Google Scholar 

  10. Gebhard F, Pfetsch H, Steinbach G et al (2000) Is interleukin 6 an early marker of injury severity following major trauma in humans? Arch Surg 135:291–295

    Article  CAS  PubMed  Google Scholar 

  11. Haasper C, Kalmbach M, Dikos GD et al (2010) Prognostic value of procalcitonin (PCT) and/or interleukin-6 (IL-6) plasma levels after multiple trauma for the development of multi organ dysfunction syndrome (MODS) or sepsis. Technol Health Care 18:89–100

    CAS  PubMed  Google Scholar 

  12. Hensler T, Heinemann B, Sauerland S et al (2003) Immunologic alterations associated with high blood transfusion volume after multiple injury: effects on plasmatic cytokine and cytokine receptor concentrations. Shock 20:497–502

    Article  PubMed  Google Scholar 

  13. Hensler T, Sauerland S, Bouillon B et al (2002) Association between injury pattern of patients with multiple injuries and circulating levels of soluble tumor necrosis factor receptors, interleukin-6 and interleukin-10, and polymorphonuclear neutrophil elastase. J Trauma 52:962–970

    Article  CAS  PubMed  Google Scholar 

  14. Hoch RC, Rodriguez R, Manning T et al (1993) Effects of accidental trauma on cytokine and endotoxin production. Crit Care Med 21:839–845

    Article  CAS  PubMed  Google Scholar 

  15. Hubl W, Wolfbauer G, Streicher J et al (1999) Differential expression of tumor necrosis factor receptor subtypes on leukocytes in systemic inflammatory response syndrome. Crit Care Med 27:319–324

    Article  CAS  PubMed  Google Scholar 

  16. Jastrow KM III, Gonzalez EA, Mcguire MF et al (2009) Early cytokine production risk stratifies trauma patients for multiple organ failure. J Am Coll Surg 209:320–331

    Article  PubMed  Google Scholar 

  17. Lausevic Z, Lausevic M, Trbojevic-Stankovic J et al (2008) Predicting multiple organ failure in patients with severe trauma. Can J Surg 51:97–102

    PubMed Central  PubMed  Google Scholar 

  18. Liener UC, Bruckner UB, Knoferl MW et al (2002) Chemokine activation within 24 hours after blunt accident trauma. Shock 17:169–172

    Article  PubMed  Google Scholar 

  19. Mace JE, Park MS, Mora AG et al (2012) Differential expression of the immunoinflammatory response in trauma patients: burn vs. non-burn. Burns 38:599–606

    Article  PubMed  Google Scholar 

  20. Maier B, Lefering R, Lehnert M et al (2007) Early versus late onset of multiple organ failure is associated with differing patterns of plasma cytokine biomarker expression and outcome after severe trauma. Shock 28:668–674

    CAS  PubMed  Google Scholar 

  21. Majetschak M, Borgermann J, Waydhas C et al (2000) Whole blood tumor necrosis factor-alpha production and its relation to systemic concentrations of interleukin 4, interleukin 10, and transforming growth factor-beta1 in multiply injured blunt trauma victims. Crit Care Med 28:1847–1853

    Article  CAS  PubMed  Google Scholar 

  22. Majetschak M, Christensen B, Obertacke U et al (2000) Sex differences in posttraumatic cytokine release of endotoxin-stimulated whole blood: relationship to the development of severe sepsis. J Trauma 48:832–839

    Article  CAS  PubMed  Google Scholar 

  23. Majetschak M, Flach R, Heukamp T et al (1997) Regulation of whole blood tumor necrosis factor production upon endotoxin stimulation after severe blunt trauma. J Trauma 43:880–887

    Article  CAS  PubMed  Google Scholar 

  24. Martin C, Boisson C, Haccoun M et al (1997) Patterns of cytokine evolution (tumor necrosis factor-alpha and interleukin-6) after septic shock, hemorrhagic shock, and severe trauma. Crit Care Med 25:1813–1819

    Article  CAS  PubMed  Google Scholar 

  25. Mommsen P, Frink M, Pape HC et al (2009) Elevated systemic IL-18 and neopterin levels are associated with posttraumatic complications among patients with multiple injuries: a prospective cohort study. Injury 40:528–534

    Article  CAS  PubMed  Google Scholar 

  26. Pape H-C, Schmidt RE, Rice J et al (2000) Biochemical changes after trauma and skeletal surgery of the lower extremity: quantification of the operative burden. Crit Care Med 28:3441–3448

    Article  CAS  PubMed  Google Scholar 

  27. Pape HC (2008) Effects of changing strategies of fracture fixation on immunologic changes and systemic complications after multiple trauma: damage control orthopedic surgery. J Orthop Res 26:1478–1484

    Article  PubMed  Google Scholar 

  28. Pape HC, Grimme K, Van Griensven M et al (2003) Impact of intramedullary instrumentation versus damage control for femoral fractures on immunoinflammatory parameters: prospective randomized analysis by the EPOFF Study Group. J Trauma 55:7–13

    Article  PubMed  Google Scholar 

  29. Pape HC, Van Griensven M, Rice J et al (2001) Major secondary surgery in blunt trauma patients and perioperative cytokine liberation: determination of the clinical relevance of biochemical markers. J Trauma 50:989–1000

    Article  CAS  PubMed  Google Scholar 

  30. Rabinovici R, John R, Esser KM et al (1993) Serum tumor necrosis factor-alpha profile in trauma patients. J Trauma 35:698–702

    Article  CAS  PubMed  Google Scholar 

  31. Roetman B, Schinkel C, Wick M et al (2008) Elevated systemic interleukin-18 in multiple injured patients is not related to clinical outcome. J Interferon Cytokine Res 28:741–747

    Article  CAS  PubMed  Google Scholar 

  32. Roumen RM, Hendriks T, Van Der Ven-Jongekrijg J et al (1993) Cytokine patterns in patients after major vascular surgery, hemorrhagic shock, and severe blunt trauma. Relation with subsequent adult respiratory distress syndrome and multiple organ failure. Ann Surg 218:769–776

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Sears BW, Stover MD, Callaci J (2009) Pathoanatomy and clinical correlates of the immunoinflammatory response following orthopaedic trauma. J Am Acad Orthop Surg 17:255–265

    PubMed Central  PubMed  Google Scholar 

  34. Seekamp A, Jochum M, Ziegler M et al (1998) Cytokines and adhesion molecules in elective and accidental trauma-related ischemia/reperfusion. J Trauma 44:874–882

    Article  CAS  PubMed  Google Scholar 

  35. Sperry JL, Friese RS, Frankel HL et al (2008) Male gender is associated with excessive IL-6 expression following severe injury. J Trauma 64:572–579

    Article  CAS  PubMed  Google Scholar 

  36. Spielmann S, Kerner T, Ahlers O et al (2001) Early detection of increased tumour necrosis factor alpha (TNFalpha) and soluble TNF receptor protein plasma levels after trauma reveals associations with the clinical course. Acta Anaesthesiol Scand 45:364–370

    Article  CAS  PubMed  Google Scholar 

  37. Strecker W, Gebhard F, Perl M et al (2003) Biochemical characterization of individual injury pattern and injury severity. Injury 34:879–887

    Article  PubMed  Google Scholar 

  38. Strecker W, Gebhard F, Rager J et al (1999) Early biochemical characterization of soft-tissue trauma and fracture trauma. J Trauma 47:358–364

    Article  CAS  PubMed  Google Scholar 

  39. Svoboda P, Kantorova I, Ochmann J (1994) Dynamics of interleukin 1, 2, and 6 and tumor necrosis factor alpha in multiple trauma patients. J Trauma 36:336–340

    Article  CAS  PubMed  Google Scholar 

  40. Tschoeke SK, Hellmuth M, Hostmann A et al (2007) The early second hit in trauma management augments the proinflammatory immune response to multiple injuries. J Trauma 62:1396–1404

    Article  PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. van Griensven gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Experimentelle Unfallchirurgie, Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland

    M. van Griensven

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Correspondence to M. van Griensven.

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van Griensven, M. Zytokine als Marker bei Polytrauma. Unfallchirurg 117, 699–702 (2014). https://doi.org/10.1007/s00113-013-2543-6

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