Skip to main content

Cytokine gene expression can predict infectious complications following severe trauma

Introduction

Identifying a group of patients at high risk of developing infectious complications is the first step in the introduction of effective pre-emptive therapies in specific patient groups. Quantifying cytokine gene expression also furthers our understanding of trauma-induced immunosuppression. Our group has already demonstrated that a predictive immunological signature derived from mRNA expression in elective thoracic surgical patients accurately predicts pneumonia risk [1].

Methods

In total, 121 ventilated polytrauma patients were recruited. mRNA was extracted from PaxGene tubes collected within 2 hours of the initial insult, at 24 and 72 hours. T-helper cell subtype specific cytokines and transcription factors mRNA was quantified using qPCR. Ten healthy controls served as a comparator.

Results

The Median Injury Severity Score (ISS) was 29. Time 0 bloods demonstrated a reduction in TNFα, IL-12§, IL-23, RORγT* and T bet§, and an increase in IL-10* and IL-4 mRNA levels in comparison with the control group (*P < 0.0001, P < 0.001 to 0.0001, P < 0.01 to 0.001, § P < 0.05 to 0.01). There was a positive correlation between ISS and IL-10 whilst both IL-23§ and RORγT were negatively correlated at time 0. TNFα, IL-10* and IL-27 increased and IFNγ, IL-12*, IL-17A§, RORγT* and T bet* mRNA levels decreased over the initial 24 hours. Subsequent bacteraemia (18/121 patients) was associated with a lower TNFα/IL-10 ratio at baseline. Similarly, higher IL-10 and lower T bet mRNA at 24 hours also predicted later bacteraemic episodes. Development of pneumonia followed a similar pattern. A multivariate logistical regression model proved highly accurate in predicting infectious complications from mRNA analysis of early blood samples. See Figure 1.

Figure 1
figure1

Cytokine mRNA levels in trauma (time 0) and control groups.

Conclusion

Cytokine gene expression patterns indicate an immediate and sustained impairment in Th1, Th17 and innate immunity with concurrent upregulation of the Th2 response following major trauma. The magnitude of this response predicts subsequent infectious complications.

References

  1. 1.

    White M, et al.: Chest. 2011, 139: 626-632. 10.1378/chest.10-0016

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to HD Torrance.

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

Torrance, H., Brohi, K., Hinds, C. et al. Cytokine gene expression can predict infectious complications following severe trauma. Crit Care 17, P27 (2013). https://doi.org/10.1186/cc11965

Download citation

Keywords

  • Infectious Complication
  • Injury Severity Score
  • Cytokine Gene Expression
  • Median Injury
  • Median Injury Severity Score