Macrophage Migration Inhibitory Factor And Interleukin-8 Could Aid In Surgical Decision-making In Patients With Multiple Blunt Trauma
|Full paper||Not Available|
This study was designed to determine serum concentrations of macrophage migration inhibitory factor (IvIlF) and interleukin-8 (7L-8).in blunt tilauma patients and to evaluate their association with surgical decision-making and patient outcome. The study included 45 trauma patients. All patients underwent clinical evaluation using Injury Severity Saore (ES) and gave blood samples, within the first 4 hours after trauma for estimation of serum levels of MIF and IL-8 using ELISA technique. Patients were followed up for either discharge from ICU or the development of adult respiratory distress syndrome (ARDS), systemic inflammatory response syndrome (SIRS), Or multiple organ dysfunction syndrome (MOD). There were 29 patients with 1$S25, 14 with ISS=25-<50 and only 2 patients with I55>50; 27 patients underwent surgical exploration (12 admitted to ICU and 15 were admitted to surgical wards); the other 18 patients were managed conservatively at either surgical ward or ICU according to•their general condition. Thirtythree patients passed smooth follow-up free of morbidity and were discharged; whereas 7 patients developed ARDS, 3 developed SIRS and 2 had MOD. Patients who developed compile. ations had significantly higher (p<0.05) ISS score compared to those passed free follow-up. Ten patients (22.2%) had died during follow-up, 4 patients died postoperatively at ICU, while the other 6 patients were managed conservatively at ICU with survival rate after conservative treatment of 66.7% and 85.2% after surgical treatment with a non-significant difference. Five patients had ARDS, 3 had SIRS and 2 had MOD, all had significantly higher (p<0.05) ISS score compared to survivors. Mean serum level of MIF was significantly increased (p<0.05) in complicated patients and in patients who developed SIRS orMOD compared to those who develoPed ARDS. Furthermore, mean serum 'level of MIF was significantly increased (p<0.05) in nonsurvivors compared to survivors. Similarly, mean serum level of IL-8 was significantly increased (p<0.05) in patients who developed complications and was significantly higher (p<0.05) in patients who developed ARDS and MOD in compared to those developed SIRS, however, serum levels of IL-8 were nonsignificantly higher (p>0.05) in non-survivors compared to survivors. There was a negative significant correlation between survival and ISS (r-0.611, P<0.001), and serum levels of MIF, (r=-0.509, Pc 0.001) and IL-8 (r=-0.302, P=0.041). Using ROC curve analysis revealed that estimation of serum MIF at 4- hours after trauma, (AUC=0.249) showed the highest specificity and ISS score determination at admission was the best screening test with highest sensitivity. It could be concluded that elevated serum levels of MIF and 1L-8 occur: eddy after blunt trauma and could predict the outcome as regards mortality and morbidity and thus could aid surgical decision making regarding the timing of surgical interference.