Association between increased blood interleukin-6 levels on emergency department arrival and prolonged length of hospital stay for blunt trauma in a tertiary rural hospital in south India
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2017, Vol 2, Issue 4
Abstract
Systemic immune response to injury plays a key rolenin the pathophysiological mechanism of blunt trauma [1, 2]. Inflammatory mediators such as tumour necrosis factor (TNF) alpha and interleukin-6 (IL-6) are released into the bloodstream from immune cells after recognition of damage-associated molecular patterns from injured tissues [1, 2]. The exaggerated inflammatory response after trauma potentially causes development of multiorgan dysfunctions (MODs) and prolongs length of intensive care unit (ICU) stay, which lead to increased mortality, morbidity, and medical costs [1, 3–6]. Early identification of high-risk patients is crucial to improve trauma care [7,8]. Blood IL-6 levels in human trauma have been studied [9–14]. Gebhard et al. serially measured blood IL-6 levels in patients with major trauma during the first 24 h of trauma and were the first to report the significant correlation between blood IL-6 levels during the early phase of trauma (up to 12 h after hospital admission) and injury severity score (ISS), suggesting a potential utility of IL-6 level as an early biomarker of injury severity [9]. Subsequent IL-6 studies in patients with trauma revealed a significant association between elevated blood IL-6 levels during the early phase and development of MODs [10–13]. However, the association between blood IL-6 levels during the early phase of trauma and length of ICU stay has been rarely tested, and only a few studies demonstrated the association between blood IL-6 levels and altered mortality from injury [13, 14]. Furthermore, despite investigations on the association between blood IL-6 level and ISS [9, 12, 14], the relationship between blood IL-6 levels and Abbreviated Injury Scale (AIS) score has been rarely analysed. Moreover, rapid IL-6 measurement systems including point-of-care testing are currently available for clinical practice [15]; however the investigation on potential utility of the point-of-care testing for IL-6 in blunt trauma remains insufficient. Thus, we tested the hypothesis that increased blood IL- 6 levels of blunt trauma patients on emergency department (ED) arrival are associated with poor clinical outcomes, and investigated the potential utility of rapid measurement of the blood IL-6 level in the initial phase of trauma care. We chose length of ICU stay as the primary outcome variable, and 28-day mortality and probability of survival according to Trauma and Injury Severity Score (TRISS) [16] as secondary outcome variables. We further investigated the association between the AIS scores for the six body regions and the blood IL-6 levels. We studied 222 consecutive patients with trauma who were transferred from the scene of the accident to a level I trauma centre in Japan and measured IL-6 levels by performing rapid measurement assays of blood samples on the arrival of the patient to the ED of the trauma centre.
Authors and Affiliations
Karthik Hareen
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