Cytokines (TNF-α, IL-1Ra), CortisolResponse in Patients with Severe Thoracic Trauma

Abstract

Background: Severe thoracic trauma (TT) is often associated with severe infection and multiple organ dysfunction syndrome burdened with even lethality. This study was aimed to assess the concentration of immune markers in the early posttraumatic phase hours in order to comprehend immune response to severe TT. Materials and methods: From 2015 to 2020, patients with severe TT (aged 18-74 years) and 30 healthy volunteers were enrolled in this prospective study. Results:A total of 249 patients with TT were treated, of those, 47 patients met the inclusion criteria.There was a male prevalence with male to female ratio of 6,8:1.The mean ICU stay was 12,3±8,8 days. The meanhospital stay of TT patients was 20,4±15,4 days. The mean concentration of TNF-αwas significantly higher on hours 3, 6 and 24, respectively, was 243,65±37,57 (p<0,001), 169,71±34,49 (p<0,001), 138,54±25,28 (p<0,001), whereas that of IL-1Ra - 6247,87±834,37 (p<0,001), 5829,42±385,58 (p<0,001)1229,42±257,47 (p<0,05).On day 1 of admission, the cortisol concentration in serum of patients with later inflammatory complications after severe TT was significantly lower compared to that of patients without complications and healthy volunteers (p<0,05).Conclusion: Early immunological diagnostics within the first three hours of hospitalization can facilitate a modulated immunotherapy to balance physiological and pathological immune responses to severe TT. Referring to evidence in terms of relationship of low cortisol level and later complications, future studies should focus on analysis of cortisol-based immune system disorder to extend our knowledge and understanding of TT.