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Background :The development of a Systemic Inflammatory Response Syndrome (SIRS) has been discussed to be related to the trauma load. Trauma, especially the multiple injured patient suffers blood loss in a various extent. The outcome of such patients is also linked with the need for transfusions and SIRS. Therefore, the association between the initial blood loss and the incidence of IL 6 release following multiple injuries was examined. Methods : Totally 545 patients ≥16 years and with an ISS >16 were included into this retrospective cohort study. The sample was divided according to the ATLS shock classes I-IV on admission in the trauma bay and the shock-index ( 1.5) at trauma site. The systemic levels of IL6 were measured 24 and 48 hours after admission. Data were analyzed using Kruskal-Wallis H test. The predictive quality was tested using receiver-operating curves (AUC), the independent predictive power was analyzed using binary logistic regression. The analysis was conducted using IBM SPSS® 23.0. Level of evidence III. Results :IL6 significantly increased within the first 24h according to shock (252ng – 872ng, p < 0.001). There were highly predictive values between IL6 and SIRS (24h) (AUC: 0.345 – 0.951 for ATLS shock I-IV, p < 0.001; AUC: 0.443 – 0.963 for shock-index 0.5 - 1.5, p < 0.001). ATLS shock revealed as an independent predictor for IL6 increase after 48h (p < 0.001). Conclusion :Initial shock-index at trauma site and the ATLS shock degree in the trauma bay are high predictors for IL6 release what may serve as a primer for the induction of SIRS. Very early control of blood loss seems to be the key point. However, these results might also point on the change of transfusion protocols in the multiple injured patient.

trauma and emergency care

The initial trauma associated hemorrhagic shock in the multiply injured patient has pro-inflammatory effects. A retrospective single center cohort study