Plasma levels of danger-associated molecular patterns are associated with immune suppression in trauma patients

• Published in: Intensive care medicine 2016-04, Vol.42 (4), p.551-561
• Main Authors: Timmermans, Kim, Kox, Matthijs, Vaneker, Michiel, van den Berg, Maarten, John, Aaron, van Laarhoven, Arjan, van der Hoeven, Hans, Scheffer, Gert Jan, Pickkers, Peter
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anesthesiology; Antibiotics; Cell Nucleus; Critical Care Medicine; Cross Infection - blood; Cross Infection - immunology; Cytokines; Cytokines - blood; Disease susceptibility; DNA - blood; DNA, Mitochondrial - blood; Emergency medical care; Emergency medical services; Emergency Medicine; Ethylenediaminetetraacetic acid; Female; Gene expression; Health aspects; Heat shock proteins; Histocompatibility antigens; HLA histocompatibility antigens; HSP70 Heat-Shock Proteins - blood; Humans; Immune system; Immunocompromised Host; Infection; Intensive; Intensive care; Life sciences; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Mitochondrial DNA; Mortality; Nosocomial infections; Original; Pain Medicine; Pediatrics; Plasma; Pneumology/Respiratory System; Risk factors; Sepsis; Trauma; Wounds and Injuries - blood; Wounds and Injuries - immunology
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-015-4205-3

Purpose Danger-associated molecular patterns (DAMPs) released of trauma could contribute to an immune suppressed state that renders patients vulnerable towards nosocomial infections. We investigated DAMP release in trauma patients, starting in the prehospital phase, and assessed its relationship with immune suppression and nosocomial infections. Methods Blood was obtained from 166 adult trauma patients at the trauma scene, emergency room (ER), and serially afterwards. Circulating levels of DAMPs and cytokines were determined. Immune suppression was investigated by determination of HLA-DRA gene expression and ex vivo lipopolysaccharide-stimulated cytokine production. Results Compared with healthy controls, plasma levels of nuclear DNA (nDNA) and heat shock protein-70 (HSP70) but not mitochondrial DNA were profoundly increased immediately following trauma and remained elevated for 10 days. Plasma cytokines were increased at the ER, and levels of anti-inflammatory IL-10 but not of pro-inflammatory cytokines peaked at this early time-point. HLA-DRA expression was attenuated directly after trauma and did not recover during the follow-up period. Plasma nDNA ( r  = −0.24, p  = 0.006) and HSP70 ( r  = −0.38, p