Relationship of Interleukin-4, 6, 10, 12 and Tumor Necrosis Factor-alpha Serum Levels to Severity of Injury and Clinical Outcome in Trauma Patients

PURPOSE: Trauma has been recognized to be accompanied by alterations of leukocyte, functions such as cytokine release. The regulatory mechanisms involved in these changes are still poorly defined. The aims of this prospective clinical study are to evaluate serum concentrations of cytokines in trauma patients with high risk of developing multiple organ failure, to investigate early change, and to examine the possible prognostic value of these elements. METHODS: Thirty-two patients with multiple traumatic injuries were studied. Patients were classified by age, sex, vector, Injury Severity Score (ISS), Triage Revised Trauma Score (T-RTS), and Systemic Inflammatory Response Syndrome (SIRS). Patients were categorized into two groups, depending on the severity of injury. Group 1 (n=21) consisted of patients with severe injuries and an ISS equal to or greater than 17 points. Group 2 (n=11) consisted of patients with minor injuries and an ISS less than 17 points. Whole blood and serum were obtained immediately after admission to the emergency department, and on days 1 and 3 after trauma. The post-traumatic serum levels of TNF-alpha, IL-4, IL-6, IL-10, and IL-12 were monitored using an enzyme-linked immunosorbent assay technique (ELISA). RESULTS: The 32 severely injured patients had a mean Injury Severity Score of 19.28+/-7.35 points. SIRS developed in 24 patients. Serum levels of IL-6, IL-10, and TNF-alpha were increased immediately and at 1 day and 3 days after the trauma, but the levels of IL-4 and IL-12 were not changed. Serum levels of IL-4, IL-6, IL-10, IL-12, and TNF-alpha were not related to the severity of the injury. However, the serum level of IL-10 was significantly increased at admission and on day 1 in patients who died (p<0.05 ). CONCLUSION: Serum IL-6, IL-10, and TNF-alpha levels were affected by injury. However, their levels did not correlate with the degree of injury. The serum level of IL-10 was significantly increased at admission and on day 1 in patients who died.

Prognostic Factors for the Hyperosmolar Nonketotic State

BACKGROUND: A hyperosmolar nonketotic state has been known to have a high mortality, and even now, despite this high mortality, only a few studies of this disease have been performed. We studied the prognostic factors for the hyperosmolar nonketotic state. METHODS: We retrospectively studied the cases of 40 patients who were in a hypersomolar nonketotic state when admitted to Sanggye Paik Hospital during the 6-year period from 1995 through 2000. We divided the hyperosmolar nonketotic patients into two groups, the complete recovery group and the incomplete recovery group, and compared the clinical features, the laboratory findings, and the precipitating factors between two groups. RESULTS: 1) A total of 40 patients were studied: 24 in the complete recovery group and 16 patients in the incomplete recovery group. The mortality rate was 32.5%. 2) No significant statistical difference existed among the clinical features of the two groups, except for the sex(p<0.01). 3) Among the laboratory findings of both groups, analysis revealed that the effective osmolarity was significantly higher among those in the incomplete recovery group(p<0.01). Serum sodium concentration was also significantly higher among those in the incomplete recovery group(p<0.01). Serum creatinine was also significantly higher among those in the incomplete recovery group(p<0.05). Serum bicarbonate concentration, on the other hand, was significantly lower among those in that group(p<0.05). 4) Infection was identified as the most common precipitating factor(62.5%). Among the precipitating factors of the two groups, there were significant statistical difference in pneumonia, UTI, and inappropriate glucose control. 5) A significant statistical difference existed among the initial level of onsciousness of both groups(p<0.05). 6) The only significant independent factor responsible for prognosis of nonketotic hyperosmolar state patients was the sex. CONCLUSION: The sex was only significant independent prognostic factor of nonketotic hyperosmolar state patients.