Relation of ex vivo stimulated blood cytokine synthesis to post-traumatic sepsis

The cytokine production in endotoxin stimulated blood of patients immediate ly after polytrauma with high risk for developing sepsis or multi organ fai lure was analysed. Forty patients sustaining traumatic injury with greater than or equal to 317 pts according to the Injury Severity Score (ISS), 10 o f whom developed severe sepsis (ACCP/SCCM conference 1992) were included in the study. Levels of interleukin 8 (IL-8), IL-6 and tumour necrosis factor (TNF) were measured by ELISA in endotoxin-stimulated whole blood and IL-10 and IL-6 in serum. The allotype for the bi-allelic NcoI restriction length polymorphism in the TNF locus was determined for each patient. Two to four hours after polytrauma endotoxin-stimulated synthesis of TNF an d IL-6 was found to be reduced in whole blood from patients compared to hea lthy donors, whereas no such differences were found for IL-8 synthesis. At this time, however, the patients who developed sepsis at a later stage (day 4-6) showed significantly (P < 0.05) enhanced IL-8 synthesis in endotoxin stimulated whole blood in comparison to healthy donors. The IL-6 and TNF pr oduction of their blood was significantly enhanced compared to patients wit h uncomplicated recovery. Ninety per cent of the patients developing sepsis were of the TNFB2/TNFB2 allotype, whereas this was the case for only 30% o f the non-septic group. Assessment of endotoxin-stimulated cytokine synthes is may provide a prognostic indicator for patients at high risk for develop ing a sepsis syndrome. (C) 1999 Academic Press.