Abstract
Background
Altered levels of inflammatory markers secondary to severe trauma present a major
problem to physicians and are prone to interfering with the clinical identification
of sepsis events. This study aimed to establish the profiles of cytokines in trauma
patients to characterize the nature of immune responses to sepsis, which might enable
early prediction and individualized treatments to be developed for targeted intervention.
Methods
A 15-plex human cytokine magnetic bead assay system was used to measure analytes in
citrated plasma samples. Analysis of the kinetics of these cytokines was performed
in 40 patients with severe blunt trauma admitted to our trauma center between March
2016 and February 2017, with an Injury Severity Score (ISS) greater than 20 with regard
to sepsis (Sepsis-3) over a 14-d time course.
Results
In total, the levels of six cytokines were altered in trauma patients across the 1-,
3-, 5-, 7-, and 14-d time points. Additionally, IL-6, IL-10, IL-15, macrophage derived
chemokine (MDC), GRO, sCD40 L, granulocyte colony-stimulating factor (G-CSF), and
fibroblast growth factor (FGF)-2 levels could be used to provide a significant discrimination
between sepsis and nonsepsis patients at day 3 and afterward, with an area under the
curve (AUC) of up to 0.90 through a combined analysis of the eight biomarkers (P < 0.001). Event-related analysis demonstrated 1.5- to 4-fold serum level changes
for these cytokines within 72 h before clinically apparent sepsis.
Conclusions
Cytokine profiles demonstrate a high discriminatory ability enabling the timely identification
of evolving sepsis in trauma patients. These abrupt changes enable sepsis to be detected
up to 72 h before clinically overt deterioration. Defining cytokine release patterns
that distinguish sepsis risk from trauma patients might enable physicians to initiate
timely treatment and reduce mortality. Large prospective studies are needed to validate
and operationalize the findings.
Trial registration
Clinicaltrials, NCT01713205. Registered October 22, 2012, https://register.clinicaltrials.gov/NCT01713205.
Keywords
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Article info
Publication history
Published online: December 05, 2022
Accepted:
October 16,
2022
Received in revised form:
September 4,
2022
Received:
May 8,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
