Release of anti-inflammatory mediators after major torso trauma correlateswith the development of postinjury multiple organ failure

BACKGROUND: Soluble tumor necrosis factor receptor (sTNFr) and interleukin- 1 receptor antagonist (IL-1ra) have been identified as endogenous inhibitor s of TNF-alpha and IL-1 beta, While TNF-alpha and IL-1 beta levels are not systematically elevated in postinjury patients who developed multiorgan fai lure (MOF), their involvement at the tissue level has been suggested, Our s tudy hypothesis was that levels of sTNFr-I and IL-1ra would discriminate pa tients at risk for postinjury MOF. METHODS: Serial plasma levels of sTNFr and IL-1ra were measured in 29 traum a patients at high risk for postinjury MOF, RESULTS: sTNFr-I levels were higher in MOF compared with non-MOF patients a t 12, 84, and 132 hours postinjury. MOF patients also had higher IL-1ra val ues 36, 60, 84, and 132 hours postinjury, CONCLUSIONS: Anti-inflammatory mechanisms are activated after trauma. Since increased levels of sTNFr and IL-1ra correlate with postinjury MOF, they m ay contribute to our understanding of the pathogenesis as well as predictio n of outcome. High levels of antagonists to TNF-alpha and IL-1 beta suggest tissue level involvement of these cytokines in postinjury hyperinflammatio n. Am J Surg. 1999 178:564-569. (C) 1999 by Excerpta Medica, Inc.