Prognostic impact of preclinically evaluated inflammatory mediators in polytraumatized patients

There is compelling data from several clinical studies on the impact of Var ious anti- and proinflammatory mediators on traumatized patients. Immediate trauma-related results, however, are only available from animal experiment s so far. Therefore, in this prospective clinical study the following quest ions were addressed: (I) Is there any marker in the preclinical phase that give information independent of and better than conventional studies conduc ted so far, (II) does this possible factor prove to be a (significant) pred ictor of late complications and/or poor overall outcome, and (III) does thi s mediator provide information that can alter treatment decisions? Methods: Upon approval of the local IRB/IEC, 85 patients (pts) were enrolle d who suffered from multiple injuries. The pts were rescued by the helicopt er-based service of the German Army Hospital in Ulm. The first blood sample s were drawn at the site of accident and at admission, then in hourly to da ily intervals. The plasma concentrations of following mediators were analyz ed: Prostanoids, products of O-2-radicals, soluble adhesion molecules, vari ous cytokines, C-reactive protein, creatinine kinase, and neopterin. All va lues were calculated in relation to the actual plasma protein content to el iminate fluid-induced dilution effects. Subsets of patients were performed according to the severity of trauma (ISS < 9; 9-17; 18-31; > 32), based on the different injury pattern, and survivors versus nonsurvivors as well. Results: As early as at the scene of accident, all patients revealed a seve rity-dependent increase in most mediators' plasma levels. There was, howeve r, also a pattern-related inflammatory response that was most pronounced in pts who had suffered from thoracic trauma irrespective of whether it was a ssociated with multiple trauma. In a total, 15 pts died within 72 h after t he accident. In those casualties, the plasma concentrations of prostaglandi n E-2 (P < 0.03), glutathione (P < 0.01) as well as creatinine kinase (P < 0.05) were more markedly elevated when compared with survivors. Conclusion: Although there were severity-dependent as well as pattern-relat ed releases of Various mediators, which in part were more apparent in nonsu rviving patients, we failed in proving any predictive marker to specificall y discriminate outcome.