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Early detection of increased tumour necrosis factor alpha (TNFα) and soluble TNF receptor protein plasma levels after trauma reveals associations with the clinical course
Author(s) -
Spielmann S.,
Kerner T.,
Ahlers O.,
Keh D.,
Gerlach M.,
Gerlach H.
Publication year - 2001
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1034/j.1399-6576.2001.045003364.x
Subject(s) - tumor necrosis factor alpha , medicine , multiple organ dysfunction syndrome , cytokine , systemic inflammatory response syndrome , receptor , necrosis , inflammation , injury severity score , immunology , gastroenterology , poison control , injury prevention , sepsis , emergency medicine
Background: The inflammatory response after trauma includes tumour necrosis factor alpha (TNFα) as pro‐inflammatory cytokine. Furthermore, both soluble TNF receptor proteins (sTNF‐R1 and sTNF‐R2) were described to influence the post‐traumatic inflammatory response and organ dysfunction. Method: From 47 trauma patients, blood samples were obtained at the scene of accident, at hospital admission, after 4 h, 12 h, and 24 h, and daily until day 6. Plasma levels of TNFα, sTNF‐R1 and sTNF‐R2 were measured by enzyme immunoassay (EIA) and analysed comparing clinical parameters such as injury scores (ISS, AIS), development of multiple organ dysfunction syndrome (MODS) and/or systemic inflammatory response syndrome (SIRS), and outcome. Results: Significant changes were observed in a time‐dependent manner: TNFα and soluble TNF receptor levels were elevated compared to values of healthy persons. At 4 h after trauma, TNFα and sTNF‐R2 showed an increase from initial values, which continued during the entire observation period. Severe trauma led to enhanced sTNF‐R1 levels on scene and on hospital admission. Development of SIRS along with elevated sTNFR1 began on scene and was present on admission, with increased sTNF‐R2 from day 1 to day 4. MODS (until day 6) was preceded by increased sTNF‐R2 levels on admission and up to 4 h after trauma. Outcome was associated neither with TNFα nor with soluble TNF receptor levels. Conclusion: Thus, in trauma patients, early post‐traumatic MODS and SIRS coincide with increased levels of TNFα and TNF receptor proteins, revealing different, time‐dependent changes. Hence, detection of TNFα and soluble TNF receptor proteins after trauma should pay regard to the time point of sampling.