RELEASE OF ANTIINFLAMMATORY MEDIATORS AFTER MECHANICAL TRAUMA CORRELATES WITH SEVERITY OF INJURY AND CLINICAL OUTCOME

Excessive synthesis of proinflammatory cytokines [tumor necrosis facto r (TNP)-alpha and interleukin (IL)-1 beta] after trauma has been corre lated with poor outcome, Recently, naturally occurring inhibitors of T NF-alpha and IL-1 beta have been characterized such as soluble TNF rec eptors (sTNFRs) and IL-1 receptor antagonist (IL-1ra), The present stu dy was undertaken to determine whether injury results in a rise of cir culating sTNFRs and IL-1ra, If so, whether plasma levels of these anti inflammatory mediators correlate with severity of injury and clinical outcome of these patients, Injured patients (n = 213) showed signific antly increased sTNFR and IL-1ra plasma levels throughout the observat ion period of 14 days, compared with healthy volunteers (n = 127), Pat ients with severe injury (Injury Severity Score > 16 points) revealed higher levels (p < 0.05) of sTNFRs and IL-1ra than patients with minor trauma (Injury Severity Score less than or equal to 16 points), Patie nts who died from injury demonstrated increased (p < 0.05) sTNFR p55 a nd IL-1ra plasma levels, compared with survivors. Thus, anti-inflammat ory mechanisms are activated after trauma dependent on severity of inj ury, Because increased plasma levels of anti-inflammatory reacting pro teins portended poorly for patient survival, these mediators may contr ibute to prediction of outcome after severe injury.