Expression levels of tumor necrosis factor-α and the corresponding receptors are correlated with trauma severity

This study investigated the plasma levels of tumor necrosis factor a (INF-alpha) and the expression levels of TNF receptors (TNFRs) in patients with multiple trauma, together with the association between the levels of this cytokine and these cytokine receptors with the severity of traumatic injury. Blood samples were obtained from 60 multiple trauma patients at hospital admission (within 2 h of injury), and 6-8 h and 1-5 days after admission. The plasma levels of TNF-alpha and TNFR1/TNFR2 were detected using enzyme immunoassay. TNFR1 and TNFR2 expression levels on leukocytes, including neutrophils, lymphocytes and monocytes, were determined by flow cytometry. Clinical parameters were determined by injury severity score (ISS). At hospital admission, the plasma TNF-alpha and soluble TNFR levels in the trauma patients were elevated compared with those of healthy controls. Increased expression levels of TNFR1 and TNFR2 were also detected on leukocytes, particularly on lymphocytes and monocytes. The expression levels of the cytokine and the corresponding receptors were correlated with the ISS. TNF-alpha and TNFR expression levels remained significantly elevated for up to the third to fifth day following the traumatic injury. In the trauma patients, increased levels of TNF-alpha and TNFRs were correlated with the severity of traumatic injury in the early post-injury period, supporting the hypothesis that trauma-provoked organ dysfunction may be caused by an overwhelming auto-destructive inflammatory response.