Research

Effects of probiotics on serum levels of Th1/Th2-cytokine and clinical outcomes in severe traumatic brain-injured patients: a prospective randomized pilot study

Min Tan, Jing-Ci Zhu, Jiang Du, Li-Mei Zhang and Hua-Hua Yin

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Critical Care 2011, 15:R290 doi:10.1186/cc10579

Published: 2 December 2011

Abstract (provisional)

Introduction

Traumatic brain injury (TBI) is associated with a profound immunological dysfunction manifested by a severe shift from T helper 1 (Th1) to Th2 response. This predisposes patients to infections, sepsis, and adverse outcomes. Probiotic bacteria have been shown to balance the Th1/Th2 cytokines in allergic murine models and patients. For this study, we hypothesized that the enteral administration of probiotics would adjust the Th1/Th2 imbalance and improve clinical outcomes in TBI patients.

Methods

We designed a prospective, randomized, single-blind study. Patients with severe TBI and Glasgow Coma Scale (GCS) scores between 5 and 8 were included, resulting in 26 patients in the control group and 26 patients in the probiotic group. All patients received enteral nutrition (EN) via nasogastric tube within 24-48 hours following admission. In addition, the probiotics group received 109 bacteria of viable probiotics per day for 21 days. The associated serum levels of Th1/Th2 cytokines, Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores, nosocomial infections, length of intensive care unit (ICU) stay, as well as 28-day mortality rate were studied.

Results

The patients responded to viable probiotics, and showed a significantly higher increase in serum IL-12p70 and IFN-gammalevels while also experiencing a dramatic decrease in IL-4 and IL-10 concentrations. APACHE II and SOFA scores were not significantly affected by probiotic treatment. Patients in the probiotic group experienced a decreased incidence of nosocomial infections towards the end of the study. Shorter ICU stays were also observed among patients treated with probiotic therapy. However, the 28-day mortality rate was unaffected.

Conclusions

This study showed that daily prophylactic administration of probiotics could attenuate the deviated Th1/Th2 response induced by severe TBI, and result in a decreased nosocomial infection rate, especially in the late period. Trial registration: The trial registration number for this study is ChiCTR-TRC-10000835.