Cell-mediated immunity frequently becomes severely impaired after major trauma. However, the cause of posttraumatic immune dysfunction is unclear and controversy exists over both pathophysiology and clinical revevance of these of these
abnormalities.
This study was undertaken to investigate the immune responses of patients with the major trauma. Levels of soluble IL-2R, a sensitive marker of T-cell activation and neopterin, an index of macrophage activation, were measured in 27 patients with
trauma.
Serum soluble IL-2R levels in patients with trauma were significantly higher than those of normal controls. The traumatic patients were classified according to the outcome. Patients with fatal outocome laways showed a higher soluble IL-2R levels
than
survivor. Levels of serum neopterin were also significantly increased in patients with trauma with trauma with respect to controls and this increase was related to the outcome. Patients with fatal outcome showed significantly higher
concentrations
of
serum neopterin than those of survivors.
A significant positive correlation was found between the soluble IL-2R levels and serum neopterin in survivors. Yet there is no relationship between soluble IL-2R and neopterin in non-survivors.
Soluble IL-2R was released in mononuclear cell cultures with bacterial endotoxin. Neopterin was also released after stimulation of macrophages with endotxin.
Calculating the sensitivity of the tests, a decline, as well as a refractory increase in specificity, was observed. Serum neopterin was shown to have a significant predictive value for the fatal outcome.
These data indicate that soluble IL-2R and neoptein might be useful parameters for monitoring of the clinical course in trauma patients. Moreover, they might indicate the possible central role of T-cell of T-cell and macrophage acivation in the
development of septic complications which is the most common cause of late death in trauma patients.
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