Introduction
Acute multiple trauma is a common disease in clinic, especially in emergency rescue, which will not only develop more rapidly, but also greatly increase the mortality rate if it occurs or is complicated by multiple organ dysfunction syndrome (MODS), causing adverse effects on the prognosis (1). Numerous studies have shown that when patients suffer from acute multiple trauma, the inflammation out of control will lead to the occurrence of MODS, namely the unbalance between inflammatory response system composed of immune inflammatory cells and tissues and anti-inflammatory response system, among which immune inflammatory cells play key roles (2). At present, finding a detection method that can predict MODS quickly and effectively is a common problem (3,4). Many MODSs are developed from systemic inflammatory response syndrome (SIRS); nuclear factor-κB (NF-κB) in neutrophils is a mediator involved in the genetic transcription and regulation of inflammatory factors, while interleukin-6 (IL-6) is one of the common factors leading to inflammation (5). When the body is exposed to pathogenic factors, a variety of cells in the body can be induced to produce cytokines, such as macrophages and Kupffer cells. The most common cytokines of MODS are tumor necrosis factor (TNF), IL, among which TNF-α occupies a major position. The injection of high-dose TNF-α into the human body can induce the occurrence of SIRS, eventually leading to MODS (6,7). Therefore, the occurrence of MODS in patients with acute multiple trauma was predicted in this study through detecting the NF-κB, IL −6 and TNF-α levels in peripheral blood, helping the clinical diagnosis and treatment.
Discussion
In the disease or severe trauma, failures of two or more organs in the body consecutively or simultaneously are defined as multiple organ failure (MOF). At present, more and more theories argue that MODS, instead of MOF, is more reasonable and scientific (8). Clinically, acute multiple trauma is a common disease in emergency, often seriously threatening the life of patients. There are also increasingly more studies on severe multiple trauma, but there is a lack of more accurate predictive indexes for severe multiple trauma or MODS (9). After severe trauma, infection or major surgery, the body will exhibit a significant acute inflammatory reaction, thus causing abnormal inflammatory mediator expression levels, among which inflammatory as well as anti-inflammatory mediators are the most common (10). In particular, inflammatory and anti-inflammatory mediators are in a relatively unstable state in patients with severe multiple trauma (11), and the expression levels of anti-inflammatory mediators are enhanced with the increase in inflammatory mediators, showing balance and fluctuation between inflammatory and anti-inflammatory mediators (12). In addition to the expression of inflammatory mediators, more indexes are involved in the regulation process of inflammatory mediators, which can indirectly reflect the degree of inflammatory response (13). Many studies have shown that NF-κB is an important regulatory factor in the inflammatory response process, which in turn affects the expression disorder of inflammatory mediators. Moreover, NF-κB activates the immune system in the body via early activation, exhibiting SIRS (14); continuous attack and multiple organ dysfunctions under stress state result in MODS (15). After activation, NF-κB enters neutrophils and monocytes quickly, and specifically binds to gene promoter and enhancer, which is expressed by cell regulatory factors and promotes the synthesis and release of a large number of inflammatory factors after binding and regulation, such as IL-6, IL-8 and TNF-α. The most important factors stimulating the synthesis of acute reactive protein in SIRS are IL-6 and TNF-α (16,17).
In this study, the ISS, APACHE II score, NF-κB, IL-6 and TNF-α levels in the MODS group were higher than those in the non-MODS group. With the prolongation of time, these indexes were increased. The ISS, APACHE II score, NF-κB, IL-6 and TNF-α levels in the deceased patients were obviously higher than those in survivors. With the prolongation of time, these indexes were increased, and the differences were statistically significant. It can be seen that ISS and APACHE II score, or NF-κB, IL-6 and TNF-α have great reference significance in the diagnosis of MODS. However, the multivariate logistic regression analyses of influencing factors of MODS in patients with severe multiple trauma showed that the ISS, APACHE II score, NF-κB, IL-6 and TNF-α levels were not the risk factors of MODS in patients with severe multiple trauma. Besides, the ROC curves of combined detection of NF-κB, IL-6 and TNF-α levels and ISS and APACHE II score of patients with severe multiple trauma in predicting MODS revealed that AUCs of ISS >22 points and APACHE II score >14 points in predicting MODS were significantly lower than that of combined detection of NF-κB >1.20. IL-6 >25.1 µg/l and TNF-α >2.20 ng/ml in peripheral blood, suggesting that the combined detection of NF-κB, IL-6 and TNF-α in peripheral blood of patients with severe multiple trauma has important significance in predicting MODS (18).
The pathogenesis and pathophysiological process of MODS are extremely complex, and the states of corresponding inflammatory and anti-inflammatory mediators at different stages of disease are different (19). Maintaining the relative balance between inflammation and anti-inflammation in human body is the most critical step in the treatment of MODS. The detection of inflammation-related factors, such as IL-6 and TNF-α, can reflect the autoreaction. Moreover, the intervention in NF-κB activity can ultimately interfere in the pathogenesis of MODS and improve the prognosis (20).