INDICATORS OF THE POSTTRAUMATIC INFLAMMATORY RESPONSE CORRELATE WITH ORGAN FAILURE IN PATIENTS WITH MULTIPLE INJURIES

Background: Most prognostic indices for severely injured patients are based on anatomical findings and the vital signs, The posttraumatic or gan failure, however, is thought to be triggered by the initial inflam matory response, The objective of this study was to evaluate the corre lation between the early activation of inflammation and the rate of or gan failure and death. Methods: Sixty-six patients with multiple injur ies (Injury Severity Score > 18, age 18-70 years, admission within 6 h ours after accident, survival > 48 hours) were included in this prospe ctive study, During a Id-day observation period, serial blood samples were collected starting within 30 minutes after admission, Plasma leve ls of neutrophil elastase, lactate, antithrombin III, and interleukin- 6 and -8 were determined, The clinical course and the degree of organ failure were recorded daily until death or transfer to a general ward. Results: The 66 severely injured patients had a mean Injury Severity Score of 40 points, Eleven patients died from multiple organ failure ( group 1), 38 subjects survived a single or multiple organ failure (gro up 2), and 17 patients had an uneventful recovery (group 3), The initi al plasma concentrations for neutrophil elastase (650 vs, 355 ng/nL), lactate (5.0 vs, 3.1 mmol/L), antithrombin III (48 vs, 62% from normal ), interleukin-6 (703 vs, 177 pg/mL), and interleukin-8 (1,101 vs, 301 pg/mL) were significantly different between groups 2 and 3 already in the initial posttraumatic period, Patients from group 1 presented wit h significantly higher levels of these parameters as early as 24 hours after trauma compared with group 2, Different patterns were identifie d with respect to early versus late posttraumatic organ failure. Concl usions: These data show that the degree of the initial inflammatory re sponse corresponds with the development of posttraumatic organ failure , Besides anatomically and physiologically based trauma scores, these parameters might be used as indicators for the injury severity.