Article Figures & Data
- Figure 1
Linear regression of plasma inflammatory biomarkers and ISS within the first 24 hours postinjury in the overall TD-1 (n=472) and TD-2 (n=89) survivor cohort. (A) IL-9, (B) IL-21, (C) IL-22, (D) IL-23 and (E) IL-17E/25. IL, interleukin; ISS, Injury Severity Score; TD-1, trauma database-1; TD-2, trauma database-2.
- Figure 2
Time course analysis of inflammation biomarkers in the mild, moderate and severe ISS-based groups from time of injury up to 7 days in TD-1 (University of Pittsburgh). Circulating levels of inflammatory mediators in the mild (n=180), moderate (n=170) and severe (n=122) ISS groups assessed in serial plasma samples obtained at the indicated time points. Time courses of (A) IL-9, (B) IL-21, (C) IL-22, (D) IL-23 and (E) IL-17E/25. Values are mean±SEM. *Mild versus severe, #moderate versus severe; p<0.05 by two-way analysis of variance. IL, interleukin; ISS, Injury Severity Score; TD-1, trauma database-1.
- Figure 3
Time course analysis of inflammation biomarkers in the mild, moderate and severe ISS-based groups from time of injury up to 3 days in TD-2 (Indiana university). Mean circulating levels of inflammatory mediators in the mild (n=12), moderate (n=21) and severe (n=56) ISS groups assessed in serial plasma samples obtained at the indicated time points. Time courses of (A) IL-9, (B) IL-21, (C) IL-22, (D) IL-23 and (E) IL-17E/25. Values are mean±SEM. *Mild versus severe, #moderate versus severe; p<0.05 by two-way analysis of variance. IL, interleukin; ISS, Injury Severity Score; TD-2, trauma database-2.
- Figure 4
Schematic that depicts the relationship between injury severity and the release of cytokine immune modulators after injury. Proinflammatory mediators, which are known to contribute to excess inflammation and tissue injury after trauma, continue to increase as injury severity increases. In contrast, a set of protective/reparative cytokines increase at lower and more survivable levels of injury but then become suppressed above a certain threshold of injury severity.
- Table 1
Overall demographics, trauma scores, mechanism of injury, clinical outcomes and disposition of the three injury severity groups segregated based on their ISS for the two separate databases used in the study, including TD-1 (University of Pittsburgh) and TD-2 (Indiana University)
ISS-based groups TD-1 (University of Pittsburgh) TD-2 (Indiana University) Mild
(1–15) n=180Moderate
(16–24) n=170Severe
(≥25) n=122P value Mild
(1–15) n=12Moderate
(16–24) n=21Severe
(≥25) n=56P value Demographics Age (year) 52 (37.8–64.3) 52 (35–64) 37 (26.0–51.8) <0.001*† 34 (26.5–49.8) 43 (33.5–49.0) 34 (22.5–45.0) 0.05 Sex, M/F M=125 F=55 M=118 F=52 M=87 F=35 0.93 M=12 F=0 M=15 F=6 M=41 F=15 0.12 Trauma scores ISS 10 (9–13) 19 (17–21) 34 (28–38) <0.001*†‡ 13.5 (9–14) 21 (17–22) 36 (30–43) <0.001*† Marshall Multiple Organ Dysfunction Score, average days1–7 0.4 (0–1.3) 0.6 (0–2) 1.4 (0.4–2.8) <0.001*† 1.4 (0.8–3.5) 2.5 (1.0–4.8) 4.3 (2.3–6.4) 0.003* Abbreviated Injury Scale 2005–update 2008 version Head and neck 0 (0–2) 0 (0–3) 3 (0–4) <0.001*† 0 (0–1) 1 (0–3) 2 (0–3) 0.037* Face 0 (0–0) 0 (0–0) 0 (0–2) 0.016* 1 (1–2) 1 (0–1) 1 (0–1) 0.4 Chest 1 (0–3) 3 (2–3) 3 (2-4) <0.001*†‡ 2 (2–3) 2 (2–3) 2 (1–4) 0.7 Abdomen 0 (0–2) 1 (0–2) 2 (0–4) <0.001*†‡ 1 (0–2) 2 (1–3) 2 (0–4) 0.066 Extremities 0 (0–2) 2 (0–2) 3 (2–3) <0.001*†‡ 0 (0–1) 1 (0–1) 1 (0–2) 0.2 External 1 (0–1) 1 (0–1) 1 (0–1) 0.59 0 (0–1) 2 (0–2) 4 (1.75–4.0) <0.001*† Mechanism of injury Motor vehicle crashes, n (%) 100 (55.6) 98 (57.7) 71 (58.2) 0.88 8 (66.7) 11 (52.4) 37 (66.1) 0.88 Motorcycle, n (%) 16 (8.9) 14 (8.2) 23 (18.9) 0.008 2 (16.7) 2 (9.5) 4 (7.1) 0.64 Fall, n (%) 45 (25) 39 (22.9) 18 (14.8) 0.09 0 (0) 2 (9.5) 3 (5.4) 0.81 Other, n (%) 19 (10.6) 19 (11.2) 10 (8.2) 0.69 2 (16.7) 6 (28.6) 12 (21.4) 0.80 Clinical outcomes Intensive care unit LOS (days) 2 (1–4) 4 (2–7) 10 (4–17) <0.001*†‡ 3 (2.3–4.8) 5 (3.0–12.5) 9 (4–17) <0.001* Total hospital LOS (days) 6.5 (4.0–11.3) 9 (6–15) 16 (10–27) <0.001*†‡ 5 (4–8) 15 (9.0–21.5) 17 (9.3–25.8) <0.001*‡ Mechanical ventilation (days) 0 (0–1) 0 (0–2) 4.5 (1.0–12.8) <0.001*† 2 (2.0–3.8) 3 (0–9.5) 5 (2–14) 0.082 Nosocomial infection, n (%) 29 (16.1) 41 (24.1) 57 (46.7) <0.001 1 (8.3) 7 (33.3) 26 (46.4) 0.032 Disposition Home, n (%) 112 (62.2) 75 (44.1) 43 (35.2) <0.001 6 (50.0) 8 (38.1) 17 (30.3) 0.66 Other facilities, n (%) 68 (37.8) 95 (55.9) 79 (64.8) <0.001 6 (50.0) 13 (61.2) 39 (69.6) 0.82 Physiological and biochemical parameters Shock index (heart rate/systolic blood pressure) 0.7 (0.6–0.9) 0.7 (0.6–0.9) 0.9 (0.7–1.2) <0.001*† 0.8 (0.6–0.9) 0.7 (0.6–0.8) 1.0 (0.7–1.4) 0.009 Systolic blood pressure (mm Hg) 130 (112–148) 130 (112–148) 118 (95–136) <0.001*† 125 (110–136) 139 (124–142) 110 (92–128) 0.001 Base deficit (mEq/L) 4 (7–1) 4 (6–3) 6 (9–3) 0.001*† 3 (6.5–2.0) 4 (6.5–3.0) 5.5 (8–3) 0.17 Lactate (mmol/L) 2.3 (1.3–3.3) 2.4 (1.4–3.5) 3.2 (2.1–4.4) <0.001*† 2.1 (1.2–4.1) 2.9 (2.5–4.5) 4.2 (2.9–5.6) 0.31 Creatinine (mg/dL) 1 (0.8–1.1) 1 (0.8–1.2) 1 (0.9–1.3) 0.099 1.1 (0.9–1.2) 1 (0.9–1.1) 1.1 (0.9–1.3) 0.45 White blood cell count (×103/µL) 13.4 (10.6–16.9) 14.0 (10.5–18.9) 16.0 (11.8–21.3) <0.001* 15.8 (9.3–17.6) 16.8 (14.0–19.9) 18.2 (12.5–26) 0.13 International normalized ratio 1.1 (1.1–1.2) 1.1 (1.1–1.2) 1.2 (1.1–1.3) <0.001*† 1.1 (1.0–1.1) 1.1 (1.1–1.2) 1.2 (1.1–1.3) 0.005*† The mild ISS group (ISS: 1–15, n=180 and n=12), moderate ISS group (ISS: 16–24, n=170 and n=21) and severe ISS group (ISS: ≥25, n=122 and n=56) in TD-1 and TD-2, respectively.
Values are expressed as median (IQR).
P<0.05 by one-way analysis of variance.
*Mild versus severe.
†Moderate versus severe.
‡Mild versus moderate.
ISS, Injury Severity Score; LOS, length of stay; TD-1, trauma database-1 ; TD-2, trauma database-2 .
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