Interleukin 13 and inflammatory markers in human sepsis.

BACKGROUND: Interleukin (IL) 13 is an anti-inflammatory cytokine that reduces inflammatory cytokine production, and enhances monocyte survival and MHC class II and CD23 expression. The only report of IL-13 in human sepsis noted no increase in IL-13 concentration, in contrast to animal data. This study further examined the expression of IL-13 in relation to human sepsis. METHODS: In a prospective observational study of 31 patients (24 men) with sepsis or septic shock, high-sensitivity enzyme-linked immunoabsorbent assay (ELISA) was used to quantify levels of tumour necrosis factor (TNF) alpha on admission, and on days 1, 3, 5 and 7 thereafter. IL-13 and IL-2 were assayed by standard ELISA, and HLA-DR on CD14-positive monocytes was measured by flow cytometry. RESULTS: Twenty-three patients developed septic shock. Monocyte HLA-DR levels showed greater depression and a slower recovery in shocked than non-shocked patients. The serum IL-13 concentration was significantly higher in the shocked group from admission to day 3, but subsequently decreased to levels similar to those in the non-shocked group. IL-13 concentrations were higher in non-survivors. The TNF-alpha concentration was higher in those with septic shock than in those without. The TNF-alpha level correlated with IL-13 concentration (r(S) = 0.61, P = 0.002). The IL-13/TNF-alpha ratio was greater in patients with shock than those with sepsis only (P = 0.017). IL-2 was undetectable. CONCLUSION: In human sepsis and septic shock, IL-13 correlated with TNF-alpha expression, but its effect on HLA-DR class II molecules remains unclear.

Motorcycle injury and survival: improving outcomes.

The aim of this study was to examine all motorcycle accident injuries presenting in Yorkshire, United Kingdom, and to assess the impact of the introduction of a consultant-led trauma team on mortality, 1993-2000. Data were collected on 1239 patients. Factors independently associated with survival by logistic regression were: the presence of abdominal trauma (odds ratio 0.46, 95% confidence interval 0.31 to 0.68), the presence of chest trauma (OR 0.41, 0.29 to 0.6), the presence of head trauma (OR 0.36, 0.30 to 0.45), requirement of a blood transfusion in the emergency room (OR 0.88/unit of blood, 0.72 to 1.07), presence of the trauma team (OR 0.43, 0.16 to 1.03) and the number of years into the program (OR 1.34/year, 1.07 to 1.67). The single factor determining improved survival was the time into the study. This shows that treatment of motorcycle trauma has improved overall with time. We propose that the introduction of uniform treatment protocols and improvements in the general standard of care have had a great effect.