Surgery News - February 2008 - (Page 20)

20 TRAUMA SURGERY NEWS • F E B R U A RY 2 0 0 8 Early Cytokine Levels Predicted Multiple Organ Failure BY BRUCE JANCIN Else vier Global Medical Ne ws C O L O R A D O S P R I N G S — A pattern of dramatically elevated serum cytokine levels within the first 6 hours after major torso trauma appears to identify patients at increased risk for subsequent multiple organ failure more effectively than do the Injury Severity Score and other traditional predictors, Dr. David W. Mercer said at the annual meeting of the Western Surgical Association. These early changes in cytokine production not only mark a high-risk patient subset, but may also point to novel therapies aimed at preventing multiple organ failure (MOF), the leading cause of death among acutely injured patients in the ICU, added Dr. Mercer, an ACS Fellow and chief of general surgery, trauma, and critical care at the University of Texas, Houston. He presented a prospective, observational study of 48 patients with major torso trauma who underwent a standardized shock resuscitation protocol with measurement of numerous serum cytokines every 4 hours for the first 24 hours after beginning resuscitation. In all, 11 patients developed MOF, of whom 7 died (64% mortality). In contrast, only 1 of 37 patients without MOF died (less than 3% mortality). The MOF group had an average of 3.5 ICU-free days, versus 17.8 days for non-MOF patients. None of the traditional predictors of MOF—Injury Severity Score, age, admission hemoglobin, base deficit, and international normalized ratio—differed signif- Membership in the American College of Surgeons? H E R E ’ S W H Y I T ’ S I M P O R TA N T: AS A BODY REPRESENTING ALL OF SURGERY, THE COLLEGE: • Provides a cohesive voice addressing societal issues related to surgery. • Is working toward having an increasingly proactive and timely voice in setting a national tone and agenda with regard to health care. • Is dedicated to promoting the highest standards of surgical care through education of and advocacy for its Fellows and their patients. • Serves as a national forum through which surgeons can reinforce the values and ethics that traditionally have characterized the surgical profession. HERE ARE SOME OF THE MANY BENEFITS BEING A MEMBER OF THE COLLEGE AFFORDS YOU: • Free registration at the Clinical Congress • Access to the College’s free coding consultation hotline • Subscription to ACS NewsScope, the College’s weekly electronic newsletter • Subscription to the Bulletin of the American College of Surgeons • Subscription to the Journal of the American College of Surgeons • Access to all College-sponsored insurance, credit card, and other helpful programs • Free posting of resume on ACS Career Opportunities • Access to Surgeons Diversiﬁed Investment Fund THERE IS STRENGTH IN NUMBERS. Our members represent every specialty, practice setting, and stage of practice. Their views and concerns are helping to shape the College’s agenda for the future. If you aren’t a member of the American College of Surgeons, apply for Fellowship today. If you are already a member, maintain that status and consider getting involved in the work of the College. Only by banding together and using our collective strength can we bring about positive change for our patients and ourselves—and for surgeons of the future. icantly between patients who subsequently developed MOF and those who didn’t. However, both inflammatory and antiinflammatory cytokine levels were markedly elevated in the MOF group within the first 6 hours after trauma. Among them were interleukin-6 and -8, tumor necrosis factor–α, and interferon-γ, as well as cytokines IL-10 and IL-1-receptor antagonist. Also elevated were several nontraditional cytokines, including eotaxin and granulocyte colony-stimulating factor. For years, Dr. Mercer has studied the hypothesis that shock-induced gut inflammation plays a major role in the pathogenesis of MOF. Recently, Dr. Mercer has shown that ketamine, an anesthetic with anti-inflammatory actions, inhibits lipopolysaccharideinduced gastric dysfunction and prevents endotoxic shock from progressing to MOF (Eur. Surg. Res. 2007;40:184-9). Discussant Dr. Serum cytokines James G. Tyburski were markedly of Detroit Receivelevated in the ing Hospital obMOF group within served that in this 6 hours after 48-patient study, trauma. many traditional DR. MERCER MOF predictors tended to differ between the MOF and non-MOF groups. He speculated that with more patients, the trend would have firmed up and achieved significance. Dr. Mercer agreed that this was quite likely, but he noted that even in this relatively small study the cytokine differences did reach significance. Pressed by Dr. Tyburski to name the single cytokine most worth measuring to predict MOF risk, Dr. Mercer said most researchers would argue that it’s IL-6. This study should interest not only trauma surgeons but also general surgeons, as the science applies to general surgical emergencies, said Dr. Grace S. Rozycki, an ACS Fellow who commented on the study. “It would be helpful to drill down some more and analyze the age extremes to determine if there is a relationship between the cytokines and comorbid factors,” said Dr. Rozycki, chief of trauma/surgical critical care, Emory University, Atlanta. “This can be very helpful in determining which patients to treat, as some of the cytokines, especially IL-6, are endogenously produced by inflamed endothelial cells.” ■ INDEX OF ADVERTISERS The Chatham Institute/Wyeth Pharmaceuticals Inc. CME 10 Ethicon, Inc. Bariatric Edge General Scientific Corporation SurgiTel KCI InfoV.A.C. Wyeth Pharmaceuticals Inc. TYGACIL 5 9 11 23-24 Information on becoming a member of the College and an application form are available online at w w w.f ac s .org/dept /fellowship/index .html or contact Cynthia Hicks, Credentials Section, Division of Member Services, via phone at 1-800/293-9623, or via e-mail at chicks@facs.org. http://www.facs.org/dept/fellowship/index.html http://www.facs.org/dept/fellowship/index.html

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Surgery News - February 2008 Contents IOM Committee Looks Into Safety Of Work Schedules Expertise Can Extend Liver Resectability Report Faults Specialty Hospitals' EDs Meeting Expectations Silver Lining HOD on Health Longer Liver Life?

Surgery News - February 2008

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