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Alterations in serum IL-6 levels in traumatized pediatric patients: A preliminary study for second hit concept
Serkan Erkus1, Ali Turgut2, Onder Kalenderer2
1Van Training and Research Hospital, Department of Orthopedics and Traumatology, Van, Turkey.
Insights
Serum interleukin-6 (IL-6) levels indicate increased inflammatory response in pediatric trauma patients. Higher trauma severity correlates with elevated IL-6, which returns to normal levels within days post-injury or surgery.
Area of Science:
- Pediatric critical care
- Trauma immunology
- Biomarker research
Background:
- The inflammatory response in pediatric patients with multiple injuries can be monitored using serum interleukin-6 (IL-6) levels.
- Previous studies have not fully evaluated the relationship between trauma severity and IL-6 in children.
Purpose of the Study:
- To investigate the severity of the inflammatory response in pediatric patients with varying degrees of trauma, using serum IL-6 levels.
- To establish the correlation between trauma severity, measured by MISS, and serum IL-6 concentrations.
Main Methods:
- Comparative study involving three groups: isolated long-bone fracture (n=30), multi-system injury (n=49) stratified by MISS score, and healthy controls (n=100).
- Serum IL-6 levels were measured on specific days post-trauma (3rd, 5th, 10th) and around surgical procedures.
- Statistical analysis was performed to determine the relationship between trauma severity and IL-6 levels.
Main Results:
- Mean serum IL-6 levels were significantly higher in trauma groups (16.1 pg/mL for isolated fracture, 46.4-74.2 pg/mL for multi-system injury) compared to controls (8.6 pg/mL).
- A moderate correlation was found between the Multiple Injury Severity Score (MISS) and IL-6 levels (p < 0.001).
- IL-6 levels in multi-system injury patients decreased significantly by the 10th day, approaching normal levels.
Conclusions:
- Serum IL-6 levels are significantly elevated in pediatric patients with increasing trauma severity.
- Systemic inflammation, indicated by IL-6, can normalize within days following trauma or surgery.
- The potential for a 'second hit' phenomenon following surgery in pediatric trauma patients warrants consideration.
Background:
The inflammatory response of pediatric patients to multiple injuries can be monitored by serum interleukin-6 levels. The aim of this study was to investigate the severity of the inflammatory response accordingly interleukin-6 (IL-6) which have not been evaluated before.
Methods:
There were 30 patients with an isolated long-bone fracture in group 1 and 49 patients with multi-system injury with at least a fracture in group-2. In group-2 were divided into two subgroups according to MISS (cut-off value = 17). Group-3 was composed of 100 healthy children as the control group to determine the normal range of serum IL-6 levels. In group-2, blood samples were taken on the 3rd, 5th, and 10th days, and if the patient was operated, additional samples were taken before the surgery and on the postoperative 1st, 5th, and 10th days. The relationship between trauma severity and serum IL-6 levels was analyzed statistically.
Results:
Mean serum IL-6 levels were 16.1, 46.4, 74.2 and 8.6 pg/mL respectively (group-1, -2A, -2B, and -3). There was a moderate correlation between MISS and IL-6 (p < 0.001). In group-2A, mean serum IL-6 levels were 13.9 pg/mL on the 3rd day and 9.1 on the 10th day. In group-2B they were 15.4 and 4.7 pg/mL, respectively. Also, for the patients undergoing surgically in group-2A, they were 36.0 pg/mL before the surgery, 33.2 on the 1st day, and 6.0 on the 10th day. For group-2B, they were 39.3, 37.4, and 7.9 pg/mL, respectively.
Conclusion:
It was determined that serum IL-6 levels were significantly increased with increasing trauma severity. Systemic inflammation specified by IL-6 could decrease to almost normal on the 3rd day, and regress to normal on the following days. The concept of "second hit impact following surgical procedure" may also be kept in mind in children as in adults considering these alterations.
