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This article is part of the supplement: 33rd International Symposium on Intensive Care and Emergency Medicine

Poster presentation

Cytokine gene expression can predict infectious complications following severe trauma

HD Torrance*, K Brohi, CJ Hinds and MJ O'Dwyer

  • * Corresponding author: HD Torrance

Author Affiliations

Bart's Health NHS Trust, London, UK

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Critical Care 2013, 17(Suppl 2):P27  doi:10.1186/cc11965


The electronic version of this article is the complete one and can be found online at: http://ccforum.com/content/17/S2/P27


Published:19 March 2013

© 2013 Torrance et al.; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction

Identifying a group of patients at high risk of developing infectious complications is the first step in the introduction of effective pre-emptive therapies in specific patient groups. Quantifying cytokine gene expression also furthers our understanding of trauma-induced immunosuppression. Our group has already demonstrated that a predictive immunological signature derived from mRNA expression in elective thoracic surgical patients accurately predicts pneumonia risk [1].

Methods

In total, 121 ventilated polytrauma patients were recruited. mRNA was extracted from PaxGene tubes collected within 2 hours of the initial insult, at 24 and 72 hours. T-helper cell subtype specific cytokines and transcription factors mRNA was quantified using qPCR. Ten healthy controls served as a comparator.

Results

The Median Injury Severity Score (ISS) was 29. Time 0 bloods demonstrated a reduction in TNFα, IL-12§, IL-23, RORγT* and T bet§, and an increase in IL-10* and IL-4mRNA levels in comparison with the control group (*P <0.0001, P <0.001 to 0.0001, P <0.01 to 0.001, §P <0.05 to 0.01). There was a positive correlation between ISS and IL-10whilst both IL-23§ and RORγTwere negatively correlated at time 0. TNFα, IL-10* and IL-27increased and IFNγ, IL-12*, IL-17A§, RORγT* and T bet* mRNA levels decreased over the initial 24 hours. Subsequent bacteraemia (18/121 patients) was associated with a lower TNFα/IL-10 ratioat baseline. Similarly, higher IL-10and lower T betmRNA at 24 hours also predicted later bacteraemic episodes. Development of pneumonia followed a similar pattern. A multivariate logistical regression model proved highly accurate in predicting infectious complications from mRNA analysis of early blood samples. See Figure 1.

thumbnailFigure 1. Cytokine mRNA levels in trauma (time 0) and control groups.

Conclusion

Cytokine gene expression patterns indicate an immediate and sustained impairment in Th1, Th17 and innate immunity with concurrent upregulation of the Th2 response following major trauma. The magnitude of this response predicts subsequent infectious complications.

References

  1. White M, et al.:

    Chest. 2011, 139:626-632. PubMed Abstract | Publisher Full Text OpenURL