Interleukin-6 and Interleukin-10 concentrations as predictors of patient outcome following major traumatic injury

Trauma is one of the main causes of death worldwide, accounting for 4.8 million deaths peryear. This death rate has led to trauma being classed as the top cause of death for males,aged between fifteen and twenty-nine. More recently, however, the pattern of majortrauma is reported to be changing, with elderly cohorts and falls from less than 2 metersemerging as the dominant presenting complaint. In addition to these deaths, directly causedin the early phase following major trauma, a second peak of deaths resulting from thecomplications including sepsis and multiple organ failure, occurs in the days and weeksfollowing the initial traumatic insult. These complications develop due to an imbalance between the pro-inflammatory and antiinflammatoryresponse to traumatic injury. This imbalance results in the counterinflammatory response becoming dominant. This results in complications including sepsisand multi-organ failure occurring due to the resultant immunosuppression. Thus, the abilityto monitor the pro- and anti-inflammatory responses through the measurement ofinterleukin-6 and interleukin-10, may allow an early prediction of patient outcome and thelikelihood of developing complications. Blood samples and clinical data were taken on days 1, 3 and 5, with additional clinical datataken on day 8, following admission. Patient blood serum was analysed for their interleukin-6 and interleukin-10 concentrations, using cytometric bead arrays, in sequential samples,over a five-day period following traumatic injury. The concentrations of interleukin-6 and interleukin-10 for these patients were thencompared to their clinical data and scoring systems. This evaluated the use of interleukin-6or interleukin-10 as potential biomarkers for the early detection of complications and poorclinical outcome following trauma. Metabolomic analysis was also conducted in parallel tovalidate methodology and identify new molecules and pathways involved in the response totrauma. Interleukin-10 concentration was further utilised to cluster liquid chromatography/massspectrometry metabolomic analysis to identify significant metabolites that are higher inpatients with elevated interleukin-10. Preliminary results show that both interleukin-6 and interleukin-10 differentiate betweengood and poor outcome. Median interleukin-6 concentrations were found to be at theirpeak in day 1 (54.28 pg/ml ± 214.48), decreasing in day 3 (29.43 pg/ml ± 300.19) and furtherdecreasing in day 5 (10.90 pg/ml ± 673.74). A similar pattern was observed followinganalysis for interleukin-10 with the peak on day 1 (5.87 pg/ml ± 20.21), decreasing in day 3(2.59 pg/ml ± 4.96) and decreasing further in day 5 (1.99 pg/ml ± 8.82). Furthermore, Day 1interleukin-10 concentrations were used to cluster the metabolomic analysis. With thisgrouping, a significant change in penicillin based antibiotic metabolites was observed in day5 metabolomic analysis of trauma patient’s serum samples, identifying day 1 interleukin-10a predictive marker for the need for long term antibiotic usage. This study indicates that the balance between interleukin-6 and interleukin-10 has potentialpredictive value for the early detection of complications following trauma and provide earlyguidance towards optimal therapeutic intervention.

Level dc:type.qualificationlevel

Master's Level (Level 7)

Year dc:date.issued

2017

Author dc:creator

• Jones, MA

Language dc:language

en

Identifier

oai:salford-repository.worktribe.com:1387174

OAI identifier oai:identifier

oai:salford-repository.worktribe.com:1387174