Different pattern of local and systemic release of proinflammatory and anti-inflammatory mediators in severely injured patients with chest trauma

J Trauma. 1996 Jun;40(6):907-12; discussion 912-4. doi: 10.1097/00005373-199606000-00008.


Background: Excessive release of proinflammatory cytokines has been involved in pathogenesis of acute respiratory distress syndrome.

Design: Since injured patients with chest trauma reveal a high risk for posttraumatic acute respiratory distress syndrome, local and systemic release of proinflammatory cytokines and their naturally occurring inhibitors were determined in the early posttraumatic period.

Materials and methods: Proinflammatory and anti-inflammatory mediators were measured in plasma and bronchoalveolar lavage fluid (BALF) from 16 patients with multiple injuries including severe chest injury (Injury Severity Score of 34.4 +/- 2.3 points) and compared with healthy volunteers (n = 17).

Results: Tumor necrosis factor-alpha was detectable neither in plasma nor in BALF. Interleukin-1beta and interleukin-8 were significantly increased in BALF from injured patients, while plasma levels were similar in both groups. Soluble tumor necrosis factor receptors p55 and p75 and interleukin-1ra were markedly elevated in plasma (p < or = 0.01) and BALF (p < or = 0.001) from injured patients compared with controls.

Conclusion: Highly increased concentrations of proinflammatory cytokines in BALF, but not in circulation, indicate a strong local inflammatory response early after multiple injuries combined with chest injury rather than severe systemic inflammation. In contrast, anti-inflammatory mechanisms seem to be activated locally and systemically.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Bronchoalveolar Lavage Fluid / immunology*
  • Cytokines / analysis
  • Cytokines / blood*
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Humans
  • Injury Severity Score
  • Interleukin 1 Receptor Antagonist Protein
  • Interleukin-1 / analysis
  • Interleukin-1 / blood
  • Interleukin-8 / analysis
  • Interleukin-8 / blood
  • Male
  • Middle Aged
  • Multiple Trauma / classification
  • Multiple Trauma / complications
  • Multiple Trauma / immunology*
  • Pneumonia / etiology
  • Sialoglycoproteins / analysis
  • Sialoglycoproteins / blood
  • Thoracic Injuries / complications
  • Thoracic Injuries / immunology*
  • Tumor Necrosis Factor-alpha / analysis


  • Cytokines
  • IL1RN protein, human
  • Interleukin 1 Receptor Antagonist Protein
  • Interleukin-1
  • Interleukin-8
  • Sialoglycoproteins
  • Tumor Necrosis Factor-alpha