Skip to main content

Immune paralysis in trauma patients; implications for prehospital intervention

Introduction

Multi-trauma is one of the major indications for intensive care admission. Recovery is frequently complicated by post-injury immunological complications, caused by a dysfunctional immune system; for example, sepsis and multiple organ failure. In order to treat or prevent this immune paralysis, knowledge on the time course of immune paralysis in vivo and the pathophysiological mechanisms of immune paralysis is essential. The aim of this study is to determine factors that could predict and/or induce immunological complications in these patients to ultimately find a suitable target and timeframe for intervention.

Methods

Blood was drawn from adult multi-trauma patients (n = 94) admitted to the emergency room (ER) of the Radboud University Nijmegen Medical Center. Blood was drawn at the trauma scene by the helicopter emergency medical services (HEMS), at arrival in the ER and at days 1, 3, 5, 7, 10 and 14 after trauma. Plasma concentrations of TNFα, IL-6, IL-10, IFNγ, IL-8 and MCP-1 were determined by Luminex. Ex vivo 24-hour whole blood stimulations with LPS or pam3cys were performed and produced TNFα, IL-6 and IL-10 was measured using ELISA to determine the level of immune paralysis. Clinical data - for example, Injury Severity Scores, trauma mechanism, medication and survival - were collected from electronic patient files.

Results

The plasma IL-10 concentration at ER was 16.5-fold increased in comparison with time-point HEMS (P < 0.01). Similar but less pronounced effects were found for IL-8 and MCP-1. A significant correlation (P = 0.03, R = 0.53) was found between injury severity scores and IL-10 plasma concentration at time-point ER. Time-courses of ex vivo produced cytokines suggest that LPS-induced IL-6 and TNFα production is already decreased in the first few hours after trauma and recovering from day 5. Ex vivo IL-10 production shows an inverse pattern.

Conclusion

Immune paralysis can be established within hours after trauma. Production of anti-inflammatory IL-10 in the prehospital phase could play a crucial role in the pathogenesis. Patients with a higher injury severity score are more prone to produce excessive IL-10 in this phase. Immune stimulatory strategies applied by the HEMS or early after hospital admission could form a potential future approach to prevent immune paralysis in multitrauma patients in the intensive care ward.

Author information

Affiliations

Authors

Corresponding author

Correspondence to M Kox.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Kox, M., Timmermans, K., Vaneker, M. et al. Immune paralysis in trauma patients; implications for prehospital intervention. Crit Care 17, P9 (2013). https://doi.org/10.1186/cc11947

Download citation

Keywords

  • Emergency Room
  • Injury Severity Score
  • Helicopter Emergency Medical Service
  • Intensive Care Admission
  • High Injury Severity Score