Early inflammatory mediator response following isolated traumatic brain injury and other major trauma in humans

The inflammatory response following isolated traumatic brain injury (TBI) i s characterised by the release of pro- and anti-inflammatory mediators. In order to determine the important mediators regarding survival and outcome o f patients with severe traumatic isolated head injuries, we performed this prospective preclinical and clinical study starting upon arrival at the sit e of the accident. After approval by the local ethics board committee, 94 m ultiple-injury patients were. enrolled. Of these, 72 patients suffered from major injuries; the other 22 patients had a severe isolated brain injury a nd were allotted to subsets of survival or nonsurvival. Of the pro- and ant iinflammatory mediators (cytokines, arachidonic acid metabolites and solubl e adhesion molecules), interleukin-6 (IL-6), IL-12 and malone dialdehyde (M DA) appeared to be of specific importance; maximum IL-6 plasma levels were eightfold higher in cases of nonsurvival than in those of survival. Patient s that did not survive TBI were the only ones to express an IL-12 increase, whereas survivors and patients with other major trauma did not show any in crease within the first 24 h. An early distinct decrease of MDA showed in p atients who did not survive TBI, in contrast to survivor patients who expos ed almost constant levels during the first 24 h.