Th1- and Th2-Type Cytokines in Plasma After Major Trauma

Background., Major trauma 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 are reported. Methods. 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 gamma, 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. Results. IL-2 and interferon gamma 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. Conclusion: We conclude that in plasma no Th1/Th2 shift can be observed after major trauma.