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.