Early inflammatory mediator response following isolated traumatic brain injury and other major trauma in humans

Abstract.

The inflammatory response following isolated traumatic brain injury (TBI) is characterised by the release of pro- and anti-inflammatory mediators. In order to determine the important mediators regarding survival and outcome of patients with severe traumatic isolated head injuries, we performed this prospective preclinical and clinical study starting upon arrival at the site of the accident. After approval by the local ethics board committee, 94 multiple-injury patients were enrolled. Of these, 72 patients suffered from major injuries; the other 22 patients had a severe isolated brain injury and were allotted to subsets of survival or nonsurvival. Of the pro- and anti-inflammatory mediators (cytokines, arachidonic acid metabolites and soluble adhesion molecules), interleukin-6 (IL-6), IL-12 and malone dialdehyde (MDA) appeared to be of specific importance; maximum IL-6 plasma levels were eightfold higher in cases of nonsurvival than in those of survival. Patients that did not survive TBI were the only ones to express an IL-12 increase, whereas survivors and patients with other major trauma did not show any increase within the first 24 h. An early distinct decrease of MDA showed in patients who did not survive TBI, in contrast to survivor patients who exposed almost constant levels during the first 24 h.