Skip to main content
Erschienen in: Der Unfallchirurg 8/2014

01.08.2014 | Leitthema

Zytokine als Marker bei Polytrauma

verfasst von: Prof. M. van Griensven

Erschienen in: Die Unfallchirurgie | Ausgabe 8/2014

Einloggen, um Zugang zu erhalten

Zusammenfassung

Hintergrund

Polytrauma kann zu posttraumatischen Komplikationen wie „systemic inflammatory response syndrome“ (SIRS), „multi-organ dysfunktion syndrome“ (MODS) und Sepsis führen. Zur Zeit werden diese Komplikationen anhand klinischer und organspezifischer Parameter monitoriert. Das Immunsystem wird von dem Trauma aktiviert und Zytokine werden als Botschaftermoleküle sezerniert. Sie können im Serum bestimmt werden und sind mit der Höhe der Inflammations- bzw. Antiinflammationsreaktion assoziiert.

Ziel

Dieses Review beschreibt klinische Arbeiten, in denen Zytokine wie TNF-α, IL-1β, IL-6, IL-8 und IL-10 gemessen wurden um posttraumatische Komplikationen zu prognostizieren. Andererseits kann IL-6 bei der Entscheidung für die Art der Primäroperation hilfreich sein (Fixateur externe oder Marknagelung). Des Weiteren kann anhand von IL-6 die Stärke der Immunreaktion und somit der Zeitpunkt für die Sekundäroperation bestimmt werden.
Literatur
1.
Zurück zum Zitat Billeter A, Turina M, Seifert B et al (2009) Early serum procalcitonin, interleukin-6, and 24-hour lactate clearance: useful indicators of septic infections in severely traumatized patients. World J Surg 33:558–566PubMedCrossRef Billeter A, Turina M, Seifert B et al (2009) Early serum procalcitonin, interleukin-6, and 24-hour lactate clearance: useful indicators of septic infections in severely traumatized patients. World J Surg 33:558–566PubMedCrossRef
2.
Zurück zum Zitat Bogner V, Keil L, Kanz KG et al (2009) Very early posttraumatic serum alterations are significantly associated to initial massive RBC substitution, injury severity, multiple organ failure and adverse clinical outcome in multiple injured patients. Eur J Med Res 14:284–291PubMedCentralPubMedCrossRef Bogner V, Keil L, Kanz KG et al (2009) Very early posttraumatic serum alterations are significantly associated to initial massive RBC substitution, injury severity, multiple organ failure and adverse clinical outcome in multiple injured patients. Eur J Med Res 14:284–291PubMedCentralPubMedCrossRef
3.
Zurück zum Zitat Bone RC (1996) Immunologic dissonance: a continuing evolution in our understanding of the systemic inflammatory response syndrome (SIRS) and the multiple organ dysfunction syndrome (MODS). Ann Intern Med 125:680–687PubMedCrossRef Bone RC (1996) Immunologic dissonance: a continuing evolution in our understanding of the systemic inflammatory response syndrome (SIRS) and the multiple organ dysfunction syndrome (MODS). Ann Intern Med 125:680–687PubMedCrossRef
5.
Zurück zum Zitat Cuschieri J, Bulger E, Schaeffer V et al (2010) Early elevation in random plasma IL-6 after severe injury is associated with development of organ failure. Shock 34:346–351PubMedCentralPubMedCrossRef Cuschieri J, Bulger E, Schaeffer V et al (2010) Early elevation in random plasma IL-6 after severe injury is associated with development of organ failure. Shock 34:346–351PubMedCentralPubMedCrossRef
6.
Zurück zum Zitat Ertel W, Kremer JP, Kenney J et al (1995) Downregulation of proinflammatory cytokine release in whole blood from septic patients. Blood 85:1341–1347PubMed Ertel W, Kremer JP, Kenney J et al (1995) Downregulation of proinflammatory cytokine release in whole blood from septic patients. Blood 85:1341–1347PubMed
7.
Zurück zum Zitat Foex BA, Lamb WR, Roberts TE et al (1993) Early cytokine response to multiple injury. Injury 24:373–376PubMedCrossRef Foex BA, Lamb WR, Roberts TE et al (1993) Early cytokine response to multiple injury. Injury 24:373–376PubMedCrossRef
8.
Zurück zum Zitat Frink M, Pape HC, Van Griensven M et al (2007) Influence of sex and age on mods and cytokines after multiple injuries. Shock 27:151–156PubMedCrossRef Frink M, Pape HC, Van Griensven M et al (2007) Influence of sex and age on mods and cytokines after multiple injuries. Shock 27:151–156PubMedCrossRef
9.
Zurück zum Zitat Frink M, Van Griensven M, Kobbe P et al (2009) IL-6 predicts organ dysfunction and mortality in patients with multiple injuries. Scand J Trauma Resusc Emerg Med 17:49PubMedCentralPubMedCrossRef Frink M, Van Griensven M, Kobbe P et al (2009) IL-6 predicts organ dysfunction and mortality in patients with multiple injuries. Scand J Trauma Resusc Emerg Med 17:49PubMedCentralPubMedCrossRef
10.
Zurück zum Zitat Gebhard F, Pfetsch H, Steinbach G et al (2000) Is interleukin 6 an early marker of injury severity following major trauma in humans? Arch Surg 135:291–295PubMedCrossRef Gebhard F, Pfetsch H, Steinbach G et al (2000) Is interleukin 6 an early marker of injury severity following major trauma in humans? Arch Surg 135:291–295PubMedCrossRef
11.
Zurück zum Zitat Haasper C, Kalmbach M, Dikos GD et al (2010) Prognostic value of procalcitonin (PCT) and/or interleukin-6 (IL-6) plasma levels after multiple trauma for the development of multi organ dysfunction syndrome (MODS) or sepsis. Technol Health Care 18:89–100PubMed Haasper C, Kalmbach M, Dikos GD et al (2010) Prognostic value of procalcitonin (PCT) and/or interleukin-6 (IL-6) plasma levels after multiple trauma for the development of multi organ dysfunction syndrome (MODS) or sepsis. Technol Health Care 18:89–100PubMed
12.
Zurück zum Zitat Hensler T, Heinemann B, Sauerland S et al (2003) Immunologic alterations associated with high blood transfusion volume after multiple injury: effects on plasmatic cytokine and cytokine receptor concentrations. Shock 20:497–502PubMedCrossRef Hensler T, Heinemann B, Sauerland S et al (2003) Immunologic alterations associated with high blood transfusion volume after multiple injury: effects on plasmatic cytokine and cytokine receptor concentrations. Shock 20:497–502PubMedCrossRef
13.
Zurück zum Zitat Hensler T, Sauerland S, Bouillon B et al (2002) Association between injury pattern of patients with multiple injuries and circulating levels of soluble tumor necrosis factor receptors, interleukin-6 and interleukin-10, and polymorphonuclear neutrophil elastase. J Trauma 52:962–970PubMedCrossRef Hensler T, Sauerland S, Bouillon B et al (2002) Association between injury pattern of patients with multiple injuries and circulating levels of soluble tumor necrosis factor receptors, interleukin-6 and interleukin-10, and polymorphonuclear neutrophil elastase. J Trauma 52:962–970PubMedCrossRef
14.
Zurück zum Zitat Hoch RC, Rodriguez R, Manning T et al (1993) Effects of accidental trauma on cytokine and endotoxin production. Crit Care Med 21:839–845PubMedCrossRef Hoch RC, Rodriguez R, Manning T et al (1993) Effects of accidental trauma on cytokine and endotoxin production. Crit Care Med 21:839–845PubMedCrossRef
15.
Zurück zum Zitat Hubl W, Wolfbauer G, Streicher J et al (1999) Differential expression of tumor necrosis factor receptor subtypes on leukocytes in systemic inflammatory response syndrome. Crit Care Med 27:319–324PubMedCrossRef Hubl W, Wolfbauer G, Streicher J et al (1999) Differential expression of tumor necrosis factor receptor subtypes on leukocytes in systemic inflammatory response syndrome. Crit Care Med 27:319–324PubMedCrossRef
16.
Zurück zum Zitat Jastrow KM III, Gonzalez EA, Mcguire MF et al (2009) Early cytokine production risk stratifies trauma patients for multiple organ failure. J Am Coll Surg 209:320–331PubMedCrossRef Jastrow KM III, Gonzalez EA, Mcguire MF et al (2009) Early cytokine production risk stratifies trauma patients for multiple organ failure. J Am Coll Surg 209:320–331PubMedCrossRef
17.
Zurück zum Zitat Lausevic Z, Lausevic M, Trbojevic-Stankovic J et al (2008) Predicting multiple organ failure in patients with severe trauma. Can J Surg 51:97–102PubMedCentralPubMed Lausevic Z, Lausevic M, Trbojevic-Stankovic J et al (2008) Predicting multiple organ failure in patients with severe trauma. Can J Surg 51:97–102PubMedCentralPubMed
18.
Zurück zum Zitat Liener UC, Bruckner UB, Knoferl MW et al (2002) Chemokine activation within 24 hours after blunt accident trauma. Shock 17:169–172PubMedCrossRef Liener UC, Bruckner UB, Knoferl MW et al (2002) Chemokine activation within 24 hours after blunt accident trauma. Shock 17:169–172PubMedCrossRef
19.
Zurück zum Zitat Mace JE, Park MS, Mora AG et al (2012) Differential expression of the immunoinflammatory response in trauma patients: burn vs. non-burn. Burns 38:599–606PubMedCrossRef Mace JE, Park MS, Mora AG et al (2012) Differential expression of the immunoinflammatory response in trauma patients: burn vs. non-burn. Burns 38:599–606PubMedCrossRef
20.
Zurück zum Zitat Maier B, Lefering R, Lehnert M et al (2007) Early versus late onset of multiple organ failure is associated with differing patterns of plasma cytokine biomarker expression and outcome after severe trauma. Shock 28:668–674PubMed Maier B, Lefering R, Lehnert M et al (2007) Early versus late onset of multiple organ failure is associated with differing patterns of plasma cytokine biomarker expression and outcome after severe trauma. Shock 28:668–674PubMed
21.
Zurück zum Zitat Majetschak M, Borgermann J, Waydhas C et al (2000) Whole blood tumor necrosis factor-alpha production and its relation to systemic concentrations of interleukin 4, interleukin 10, and transforming growth factor-beta1 in multiply injured blunt trauma victims. Crit Care Med 28:1847–1853PubMedCrossRef Majetschak M, Borgermann J, Waydhas C et al (2000) Whole blood tumor necrosis factor-alpha production and its relation to systemic concentrations of interleukin 4, interleukin 10, and transforming growth factor-beta1 in multiply injured blunt trauma victims. Crit Care Med 28:1847–1853PubMedCrossRef
22.
Zurück zum Zitat Majetschak M, Christensen B, Obertacke U et al (2000) Sex differences in posttraumatic cytokine release of endotoxin-stimulated whole blood: relationship to the development of severe sepsis. J Trauma 48:832–839PubMedCrossRef Majetschak M, Christensen B, Obertacke U et al (2000) Sex differences in posttraumatic cytokine release of endotoxin-stimulated whole blood: relationship to the development of severe sepsis. J Trauma 48:832–839PubMedCrossRef
23.
Zurück zum Zitat Majetschak M, Flach R, Heukamp T et al (1997) Regulation of whole blood tumor necrosis factor production upon endotoxin stimulation after severe blunt trauma. J Trauma 43:880–887PubMedCrossRef Majetschak M, Flach R, Heukamp T et al (1997) Regulation of whole blood tumor necrosis factor production upon endotoxin stimulation after severe blunt trauma. J Trauma 43:880–887PubMedCrossRef
24.
Zurück zum Zitat Martin C, Boisson C, Haccoun M et al (1997) Patterns of cytokine evolution (tumor necrosis factor-alpha and interleukin-6) after septic shock, hemorrhagic shock, and severe trauma. Crit Care Med 25:1813–1819PubMedCrossRef Martin C, Boisson C, Haccoun M et al (1997) Patterns of cytokine evolution (tumor necrosis factor-alpha and interleukin-6) after septic shock, hemorrhagic shock, and severe trauma. Crit Care Med 25:1813–1819PubMedCrossRef
25.
Zurück zum Zitat Mommsen P, Frink M, Pape HC et al (2009) Elevated systemic IL-18 and neopterin levels are associated with posttraumatic complications among patients with multiple injuries: a prospective cohort study. Injury 40:528–534PubMedCrossRef Mommsen P, Frink M, Pape HC et al (2009) Elevated systemic IL-18 and neopterin levels are associated with posttraumatic complications among patients with multiple injuries: a prospective cohort study. Injury 40:528–534PubMedCrossRef
26.
Zurück zum Zitat Pape H-C, Schmidt RE, Rice J et al (2000) Biochemical changes after trauma and skeletal surgery of the lower extremity: quantification of the operative burden. Crit Care Med 28:3441–3448PubMedCrossRef Pape H-C, Schmidt RE, Rice J et al (2000) Biochemical changes after trauma and skeletal surgery of the lower extremity: quantification of the operative burden. Crit Care Med 28:3441–3448PubMedCrossRef
27.
Zurück zum Zitat Pape HC (2008) Effects of changing strategies of fracture fixation on immunologic changes and systemic complications after multiple trauma: damage control orthopedic surgery. J Orthop Res 26:1478–1484PubMedCrossRef Pape HC (2008) Effects of changing strategies of fracture fixation on immunologic changes and systemic complications after multiple trauma: damage control orthopedic surgery. J Orthop Res 26:1478–1484PubMedCrossRef
28.
Zurück zum Zitat Pape HC, Grimme K, Van Griensven M et al (2003) Impact of intramedullary instrumentation versus damage control for femoral fractures on immunoinflammatory parameters: prospective randomized analysis by the EPOFF Study Group. J Trauma 55:7–13PubMedCrossRef Pape HC, Grimme K, Van Griensven M et al (2003) Impact of intramedullary instrumentation versus damage control for femoral fractures on immunoinflammatory parameters: prospective randomized analysis by the EPOFF Study Group. J Trauma 55:7–13PubMedCrossRef
29.
Zurück zum Zitat Pape HC, Van Griensven M, Rice J et al (2001) Major secondary surgery in blunt trauma patients and perioperative cytokine liberation: determination of the clinical relevance of biochemical markers. J Trauma 50:989–1000PubMedCrossRef Pape HC, Van Griensven M, Rice J et al (2001) Major secondary surgery in blunt trauma patients and perioperative cytokine liberation: determination of the clinical relevance of biochemical markers. J Trauma 50:989–1000PubMedCrossRef
30.
Zurück zum Zitat Rabinovici R, John R, Esser KM et al (1993) Serum tumor necrosis factor-alpha profile in trauma patients. J Trauma 35:698–702PubMedCrossRef Rabinovici R, John R, Esser KM et al (1993) Serum tumor necrosis factor-alpha profile in trauma patients. J Trauma 35:698–702PubMedCrossRef
31.
Zurück zum Zitat Roetman B, Schinkel C, Wick M et al (2008) Elevated systemic interleukin-18 in multiple injured patients is not related to clinical outcome. J Interferon Cytokine Res 28:741–747PubMedCrossRef Roetman B, Schinkel C, Wick M et al (2008) Elevated systemic interleukin-18 in multiple injured patients is not related to clinical outcome. J Interferon Cytokine Res 28:741–747PubMedCrossRef
32.
Zurück zum Zitat Roumen RM, Hendriks T, Van Der Ven-Jongekrijg J et al (1993) Cytokine patterns in patients after major vascular surgery, hemorrhagic shock, and severe blunt trauma. Relation with subsequent adult respiratory distress syndrome and multiple organ failure. Ann Surg 218:769–776PubMedCentralPubMedCrossRef Roumen RM, Hendriks T, Van Der Ven-Jongekrijg J et al (1993) Cytokine patterns in patients after major vascular surgery, hemorrhagic shock, and severe blunt trauma. Relation with subsequent adult respiratory distress syndrome and multiple organ failure. Ann Surg 218:769–776PubMedCentralPubMedCrossRef
33.
Zurück zum Zitat Sears BW, Stover MD, Callaci J (2009) Pathoanatomy and clinical correlates of the immunoinflammatory response following orthopaedic trauma. J Am Acad Orthop Surg 17:255–265PubMedCentralPubMed Sears BW, Stover MD, Callaci J (2009) Pathoanatomy and clinical correlates of the immunoinflammatory response following orthopaedic trauma. J Am Acad Orthop Surg 17:255–265PubMedCentralPubMed
34.
Zurück zum Zitat Seekamp A, Jochum M, Ziegler M et al (1998) Cytokines and adhesion molecules in elective and accidental trauma-related ischemia/reperfusion. J Trauma 44:874–882PubMedCrossRef Seekamp A, Jochum M, Ziegler M et al (1998) Cytokines and adhesion molecules in elective and accidental trauma-related ischemia/reperfusion. J Trauma 44:874–882PubMedCrossRef
35.
Zurück zum Zitat Sperry JL, Friese RS, Frankel HL et al (2008) Male gender is associated with excessive IL-6 expression following severe injury. J Trauma 64:572–579PubMedCrossRef Sperry JL, Friese RS, Frankel HL et al (2008) Male gender is associated with excessive IL-6 expression following severe injury. J Trauma 64:572–579PubMedCrossRef
36.
Zurück zum Zitat Spielmann S, Kerner T, Ahlers O et al (2001) Early detection of increased tumour necrosis factor alpha (TNFalpha) and soluble TNF receptor protein plasma levels after trauma reveals associations with the clinical course. Acta Anaesthesiol Scand 45:364–370PubMedCrossRef Spielmann S, Kerner T, Ahlers O et al (2001) Early detection of increased tumour necrosis factor alpha (TNFalpha) and soluble TNF receptor protein plasma levels after trauma reveals associations with the clinical course. Acta Anaesthesiol Scand 45:364–370PubMedCrossRef
37.
Zurück zum Zitat Strecker W, Gebhard F, Perl M et al (2003) Biochemical characterization of individual injury pattern and injury severity. Injury 34:879–887PubMedCrossRef Strecker W, Gebhard F, Perl M et al (2003) Biochemical characterization of individual injury pattern and injury severity. Injury 34:879–887PubMedCrossRef
38.
Zurück zum Zitat Strecker W, Gebhard F, Rager J et al (1999) Early biochemical characterization of soft-tissue trauma and fracture trauma. J Trauma 47:358–364PubMedCrossRef Strecker W, Gebhard F, Rager J et al (1999) Early biochemical characterization of soft-tissue trauma and fracture trauma. J Trauma 47:358–364PubMedCrossRef
39.
Zurück zum Zitat Svoboda P, Kantorova I, Ochmann J (1994) Dynamics of interleukin 1, 2, and 6 and tumor necrosis factor alpha in multiple trauma patients. J Trauma 36:336–340PubMedCrossRef Svoboda P, Kantorova I, Ochmann J (1994) Dynamics of interleukin 1, 2, and 6 and tumor necrosis factor alpha in multiple trauma patients. J Trauma 36:336–340PubMedCrossRef
40.
Zurück zum Zitat Tschoeke SK, Hellmuth M, Hostmann A et al (2007) The early second hit in trauma management augments the proinflammatory immune response to multiple injuries. J Trauma 62:1396–1404PubMedCrossRef Tschoeke SK, Hellmuth M, Hostmann A et al (2007) The early second hit in trauma management augments the proinflammatory immune response to multiple injuries. J Trauma 62:1396–1404PubMedCrossRef
Metadaten
Titel
Zytokine als Marker bei Polytrauma
verfasst von
Prof. M. van Griensven
Publikationsdatum
01.08.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
Die Unfallchirurgie / Ausgabe 8/2014
Print ISSN: 2731-7021
Elektronische ISSN: 2731-703X
DOI
https://doi.org/10.1007/s00113-013-2543-6

Weitere Artikel der Ausgabe 8/2014

Der Unfallchirurg 8/2014 Zur Ausgabe

Einführung zum Thema

Biochemische Marker nach Trauma

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.