Selective Inhibition of IL-6 Trans-Signaling Has No Beneficial Effect on the Posttraumatic Cytokine Release after Multiple Trauma in Mice

While improvements in pre-hospital and in-hospital care allow more multiple trauma patients to advance to intensive care, the incidence of posttraumatic multiple organ dysfunction syndrome (MODS) is on the rise. Herein, the influence of a selective IL-6 trans-signaling inhibition on posttraumatic cytokine levels was investigated as an approach to prevent MODS caused by a dysbalanced posttraumatic immune reaction. Therefore, the artificial IL-6 trans-signaling inhibitor sgp130Fc was deployed in a murine multiple trauma model (femoral fracture plus bilateral chest trauma). The traumatized mice were treated with sgp130Fc (FP) and compared to untreated mice (WT) and IL-6 receptor knockout mice (RKO), which received the same traumas. The overall trauma mortality was 4.4%. Microscopic pulmonary changes were apparent after multiple trauma and after isolated bilateral chest trauma. Elevated IL-6, MCP-3 and RANTES plasma levels were measured after trauma, indicating a successful induction of a systemic inflammatory reaction. Significantly reduced IL-6 and RANTES plasma levels were visible in RKO compared to WT. Only a little effect was visible in FP compared to WT. Comparable cytokine levels in WT and FP indicate neither a protective nor an adverse effect of sgp130Fc on the cytokine release after femoral fracture and bilateral chest trauma.

Does the time of the day affect multiple trauma care in hospitals? A retrospective analysis of data from the TraumaRegister DGU®

Background Optimal multiple trauma care should be continuously provided during the day and night. Several studies have demonstrated worse outcomes and higher mortality in patients admitted at night. This study involved the analysis of a population of multiple trauma patients admitted at night and a comparison of various indicators of the quality of care at different admission times. Methods Data from 58,939 multiple trauma patients from 2007 to 2017 were analyzed retrospectively. All data were obtained from TraumaRegister DGU®. Patients were grouped by the time of their admission to the trauma center (6.00 am–11.59 am (morning), 12.00 pm–5.59 pm (afternoon), 6.00 pm–11.59 pm (evening), 0.00 am–5.59 am (night)). Incidences, patient demographics, injury patterns, trauma center levels and trauma care times and outcomes were evaluated. Results Fewer patients were admitted during the night (6.00 pm–11.59 pm: 18.8% of the patients, 0.00–5.59 am: 4.6% of the patients) than during the day. Patients who arrived between 0.00 am–5.59 am were younger (49.4 ± 22.8 years) and had a higher injury severity score (ISS) (21.4 ± 11.5) and lower Glasgow Coma Scale (GCS) score (11.6 ± 4.4) than those admitted during the day (12.00 pm–05.59 pm; age: 55.3 ± 21.6 years, ISS: 20.6 ± 11.4, GCS: 12.6 ± 4.0). Time in the trauma department and time to an emergency operation were only marginally different. Time to imaging was slightly prolonged during the night (0.00 am–5.59 am: X-ray 16.2 ± 19.8 min; CT scan 24.3 ± 18.1 min versus 12.00 pm- 5.59 pm: X-ray 15.4 ± 19.7 min; CT scan 22.5 ± 17.8 min), but the delay did not affect the outcome. The outcome was also not affected by level of the trauma center. There was no relevant difference in the Revised Injury Severity Classification II (RISC II) score or mortality rate between patients admitted during the day and at night. There were no differences in RISC II scores or mortality rates according to time period. Admission at night was not a predictor of a higher mortality rate. Conclusion The patient population and injury severity vary between the day and night with regard to age, injury pattern and trauma mechanism. Despite the differences in these factors, arrival at night did not have a negative effect on the outcome.

Examining the relationship between the NUTRIC 2002 score and the complications and mortality up to 48 hours after the discharge of multiple trauma patients admitted to the ICU of Alzahra Hospital in Isfahan (2018-2019)

Introduction: Eating disorders are among the most common problems in patients suffering from multiple trauma admitted to the ICU. They have a considerable impact on the increase of mortality risk. The present study aimed to determine the relationship between the Nutrition Risk in Critically ill (NUTRIC) score and the complications and mortality up to 48 hours after the discharge of multiple trauma patients admitted to the ICU of Alzahra Hospital in Isfahan between 2018 and 2019. Methodology: This study was descriptive-analytical research on 68 multiple trauma patients admitted to the ICU of Alzahra Hospital. The NUTRIC 2002 scores of the said patients were calculated by evaluating the parameters of age, APACHE II, SOFA Score, days in the hospital to ICU admission, and the number of comorbidities. Two different study groups were compared in terms of the said parameters, one composed of living and the other of deceased subjects. Findings: The mean NUTRIC 2002 Score was 3.5±0.03 in all studied patients. Out of the said patients, 67.6% and 32.4% of them were exposed to a low-risk eating disorder and a high-risk eating disorder, respectively. The mean of NUTRIC Scores in living and deceased patients were 2.82±3 and 1.19±5.83, respectively; which indicated that the deceased subjects had a higher NUTRIC Score (p<0.001). Conclusion: The 2002 NUTRIC Score was higher in the deceased subjects than in the living patients. Thus, this score seems to be a valuable and usable criterion for determining the eating disorder and the risk of mortality in multi-trauma patients admitted to the ICU. Keywords: NUTRIC, Multiple Trauma, Intensive Care, Death

Evaluation of nutritional risk according to screening (NRS.2002) in multiple trauma patients admitted to ICU of Alzahra Hospital in Isfahan in 2018

Introduction: Undernutrition of patients is one of the most important and effective issues in response to treatment and mortality rate. The prevalence of undernutrition in hospitalized patients is 22 to 50%. Little attention has been paid to this issue due to lack of a proper nutritional screening system. Nutrition of the patients admitted to ICU and maintaining their homeostasis requires proper and scientific management. Early nutritional support reduces the severity of disease, complications, and length of hospital stay in the intensive care unit. The aim of present study was to use the Nutritional Screening System (NRS 2002) in multiple trauma patients admitted to ICU. Methods: The present study was conducted on 100 multiple trauma patients admitted to the ICU of Al-Zahra Hospital in Isfahan in 2018. The required information form was completed for each patient. In this nutritional system, the severity of disease and level of undernutrition of patients are divided into three categories: mild, moderate and severe. In the NRS 2002 system, the final score varies from 0 to 7. The nutrition care program starts with a final score of ≥ 3. Results: In the present study, the results showed that weight loss in the last three months was 32%, and the level of nutrients received during the last week was 30%. Also, 42% of patients were severely ill and 45% needed nutritional support. Also, 68% of patients did not have undernutrition problems. Based on the independent t-test, weight loss during the last three months, reduction of calorie intake and severity of previous disease were effective in the type of treatment. Conclusion: The NRS 2002 method is very valuable and reliable due to the rapid and easy identification of undernutrition patients based on items that are readily available and its applicability if the reporter is not a nutritionist. Keywords: Nutritional Screening, Nutrition Risk, Intensive Care Unit, Multiple Trauma

Severe traumatic brain injury and hypotension is a frequent and lethal combination in multiple trauma patients in mountain areas – an analysis of the prospective international Alpine Trauma Registry

Background Hypotension is associated with worse outcome in patients with traumatic brain injury (TBI) and maintaining a systolic blood pressure (SBP) ≥110 mmHg is recommended. The aim of this study was to assess the incidence of TBI in patients suffering multiple trauma in mountain areas; to describe associated factors, treatment and outcome compared to non-hypotensive patients with TBI and patients without TBI; and to evaluate pre-hospital variables to predict admission hypotension. Methods Data from the prospective International Alpine Trauma Registry including mountain multiple trauma patients (ISS ≥ 16) collected between 2010 and 2019 were analysed. Patients were divided into three groups: 1) TBI with hypotension, 2) TBI without hypotension and 3) no TBI. TBI was defined as Abbreviated Injury Scale (AIS) of the head/neck ≥3 and hypotension as SBP < 110 mmHg on hospital arrival. Results A total of 287 patients were included. Fifty (17%) had TBI and hypotension, 92 (32%) suffered TBI without hypotension and 145 (51%) patients did not have TBI. Patients in group 1 were more severely injured (mean ISS 43.1 ± 17.4 vs 33.3 ± 15.3 vs 26.2 ± 18.1 for group 1 vs 2 vs 3, respectively, p < 0.001). Mean SBP on hospital arrival was 83.1 ± 12.9 vs 132.5 ± 19.4 vs 119.4 ± 25.8 mmHg (p < 0.001) despite patients in group 1 received more fluids. Patients in group 1 had higher INR, lower haemoglobin and lower base excess (p < 0.001). More than one third of patients in group 1 and 2 were hypothermic (body temperature < 35 °C) on hospital arrival while the rate of admission hypothermia was low in patients without TBI (41% vs 35% vs 21%, for group 1 vs 2 vs 3, p = 0.029). The rate of hypothermia on hospital arrival was different between the groups (p = 0.029). Patients in group 1 had the highest mortality (24% vs 10% vs 1%, p < 0.001). Conclusion Multiple trauma in the mountains goes along with severe TBI in almost 50%. One third of patients with TBI is hypotensive on hospital arrival and this is associated with a worse outcome. No single variable or set of variables easily obtainable at scene was able to predict admission hypotension in TBI patients.

The potential of adipokines in identifying multiple trauma patients at risk of developing multiple organ dysfunction syndrome

Background Multiple organ dysfunction syndrome (MODS) and the consecutive multiple organ failure (MOF) are severe and dreaded complications with a high mortality in multiple trauma patients. The aim of this study was to investigate the potential of the adipokines leptin, resistin, interleukin-17A and interleukin-33 as possible biomarkers in the early posttraumatic inflammatory response and for identifying severely traumatized patients at risk of developing MODS. Methods In total, 14 multiple trauma patients with an injury severity score (ISS) ≥ 16 as well as a control group of 14 non-multiple trauma patients were included in this study and blood samples were taken at the time points 0, 6, 24, 48 and 72 h after admission. For the trauma patients, the SIRS and Denver MOF score were determined daily. The quantitative measurement of the plasma concentrations of the adipokines was performed using ELISA. Results In the statistical analysis, the multiple trauma patients showed statistically significant higher plasma concentrations of leptin, resistin, IL-17A and IL-33 compared to the control group. In addition, there was a statistically significant positive correlation between the concentrations of resistin, IL-17A and IL-33 and the corresponding SIRS scores and between the concentrations of resistin, IL-17A and IL-33 and the corresponding Denver MOF scores. Finally, ROC curve analysis revealed that the adipokines leptin and IL-17A are suitable diagnostic markers for the discrimination between multiple trauma patients with and without MOF. Conclusions Leptin and IL-17A could be suitable diagnostic markers to identify severely injured patients with a developing SIRS and MOF earlier, to adjust surgical therapy planning and intensive care.