induces a dysregulation of immune response supported in parts by lymphocyte dysfunction. Controversial data about a shift within the T-helper cell subsets Th1/Th2
To prove whether Th1/Th2
-type cytokine plasma
levels reflect the postulated Th2 shift after trauma
, we investigated in a retrospective study 195 severely injured patients (47 women, 148 men; mean age 39.7 ± 15.8 years; Injury Severity Score 32.0 ± 11.3 points; overall 1,887 samples) during their ICU stay posttrauma. Mortality rate was 19%. Th1-type cytokines interleukin 2 (IL-2), interferon γ, IL-12 (p70), and IL-18 and Th2-type cytokines IL-4, IL-10, and IL-11 were determined using the enzyme-linked immunosorbant assay technique in patients and in healthy controls.
IL-2 and interferon γ were seldom detectable. All other mediators were significantly increased matched to controls (p
< 0.05). All cytokines were elevated most prominent during weeks 1 and 2 posttrauma and declined thereafter. A trend toward lower levels in nonsurvivors was seen for both groups of cytokines. However, significant differences were only seen for Injury Severity Score, age, white blood cells, and C-reactive protein. All mediators correlated positively with each other (p
< 0.01), a Th2-type shift was not observed. Two groups of patients were identified: one group with generally high plasma
levels of all cytokines investigated and a second group of nonresponders who presented with low or diminished plasma
levels in which most nonsurvivors were found.
We conclude that in plasma
shift can be observed after major trauma