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Kinetics of C-reactive protein, interleukin-6 and -10, and phospholipase A2-II in severely traumatized septic
Zeljko Lausević1, Goran Vuković, Biljana Stojimirović
1Clinical Center of Serbia, Center for Emergency Surgery, Belgrade, Serbia. zlausevic@gmail.com
Insights
Early detection of sepsis in trauma patients is crucial. C-reactive protein (CRP) levels on day one predict sepsis in patients with Injury Severity Score (ISS) 18-28, while CRP and interleukin-10 (IL-10) predict sepsis in those with ISS > 28.
Area of Science:
- Trauma and Surgical Critical Care
- Immunology and Inflammation
- Biomarker Discovery
Background:
- Sepsis is a leading cause of mortality in trauma patients, often linked to injury-induced immune suppression (anergy).
- Accurate prediction of septic complications is vital for timely intervention in young trauma victims.
Purpose of the Study:
- To assess the kinetics of interleukin-6 (IL-6), IL-10, phospholipase A2-II, and C-reactive protein (CRP) in severely traumatized patients.
- To explore the potential of these biomarkers for early sepsis detection in trauma survivors.
Main Methods:
- Prospective study of 65 trauma patients (Injury Severity Score [ISS] > 18) admitted to surgical intensive care units.
- Patients were divided into sepsis (n=41) and non-sepsis (n=24) groups.
- CRP, IL-6, IL-10, and phospholipase A2 group II levels were measured within 24 hours, and on days 2, 3, and 7 post-hospitalization.
Main Results:
- Interleukin-6 (IL-6) and phospholipase A2-II levels did not significantly differ between sepsis and non-sepsis groups at any time point.
- Septic patients with higher ISS (29-35 and >35) showed significantly lower IL-10 levels on days 2 and 7 compared to non-septic controls.
- C-reactive protein (CRP) levels were significantly higher in septic patients with ISS 18-28 on day 1, but lower on days 2, 3, and 7 for patients with ISS > 28.
Conclusions:
- Mean CRP levels on day 1 can predict sepsis in trauma patients with ISS 18-28.
- Mean CRP levels on days 2, 3, and 7 are predictive of sepsis in trauma patients with ISS > 28.
- Mean IL-10 levels on days 2 and 7 may predict sepsis in trauma patients with ISS > 28.
Background/Aim:
Injury-induced anergy is one of the key factors contributing to trauma victims' high susceptibility to sepsis. This group of patients is mostly of young age and it is therefore essential to be able to predict as accurately as possible the development of septic complications, so appropriate treatment could be provided. The aim of this study was to assess kinetics of interleukin (IL)-6 and -10, phospholipase A2-II and C-reactive protein (CRP) in severely traumatized patients and explore the possibilities for early detection of potentially septic patients.
Methods:
This prospective study included 65 traumatized patients with injury severity score (ISS) > 18, requiring treatment at surgical intensive care units, divided into two groups: 24 patients without sepsis and 41 patients with sepsis. C-reactive protein, IL-6 and -10 and phospholipase A2 group II, were determined within the first 24 hours, and on the second, third and seventh day of hospitalization.
Results:
Mean values of IL-6 and phospholipase A2-II in the patients with and without sepsis did not show a statistically significant difference on any assessed time points. In the septic patients with ISS 29-35 and > 35 on the days two and seven a statistically significantly lower level of IL-10 was found, compared with those without sepsis and with the same ISS. C-reactive protein levels were significantly higher in septic patients with ISS 18-28 on the first day. On the second, third and seventh day CRP levels were significantly lower in the groups of septic patients with ISS 29-35 and > 35, than in those with the same ISS but without sepsis.
Conclusion:
Mean levels of CRP on the first day after the injury may be useful predictor of sepsis development in traumatized patients with ISS score 18-28. Mean levels of CRP on the days two, three and seven after the injury may be a useful predictor of sepsis development in traumatized patients with ISS score more than 28. Mean levels of IL-10 on the second and seventh day after the injury may be a useful predictor of sepsis development in traumatized patients with ISS score > 28.
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