Interleukin-22 and interleukin-22 binding protein signaling axis influences intubation status in trauma

Interleukin-22 is a cytokine involved in mucosal immunity, whereas interleukin-22 binding protein is a soluble receptor that can potently block interleukin-22. The role of interleukin-22 and interleukin-22 binding protein in trauma remains unclear. This study investigates whether IL-22 levels are associated with intubation in patients with trauma. We hypothesized interleukin-22 levels would be lower in intubated patients.

Plasma samples were prospectively obtained in the trauma bay at consecutive Level 1 activations from November 2021 to November 2022. Patients were categorized as having respiratory failure (intubated) or as controls (nonintubated). Two-to-one case-control matching was conducted based on age, sex, mechanism of injury, and Injury Severity Score. Plasma interleukin-22 and interleukin-22 binding protein levels were measured by enzyme-linked immunosorbent assay.

In total, 99 patients were matched (33 respiratory failure and 66 controls), with a median age of 41 (interquartile range, 29-61). Interleukin-22 levels were lower in the respiratory failure group (32 pg/mL vs 39 pg/mL, P = .03). Lower interleukin-22 correlated with higher Injury Severity Score (r = -0.41, P < .001) and longer hospital stay (r = -0.26, P = .01). Multivariate analysis showed that lower interleukin-22 levels were independently associated with intubation (odds ratio, 0.97; 95% confidence interval, 0.95-0.99, P = .02).

Interleukin-22 may serve as a biomarker for trauma-induced respiratory failure, with lower levels associated with greater injury severity and the need for intubation. Further studies are needed to explore its potential as a therapeutic and to better understand its role in trauma care.