Abstract
Introduction: In trauma, lactic acidosis has been associated with a robust inflammatory response and poorer outcomes. However, its effect on peritoneal fluid cytokine production following trauma has not been elucidat ed. The aim of this study was to investigate how lactic acidosis affects cytokine production in peritoneal fluid of trauma patients after damage control laparotomy (DCL). It was hypothesized that peritoneal fluid cytokine levels differ in patients with elevated lactate on admission.
Methods: Peritoneal fluid was collected from adult patients undergoing DCL at a Level 1 Trauma Center for blunt or penetrating trauma. Peritoneal fluid cytokine levels were measured using a 10-analyte multiplex as say. Patients were separated by admission serum lactate level: low (= 2.5 mmol/L), medium (>2.5 mmol/L and =4 mmol/L) and high (>4 mmol/L) based on previous literature. Univariate analyses were used to compare the groups.
Results: Of the 63 samples studied, significant differences in age and admission blood alcohol level were observed amongst the 3 groups (p=0.023). IL-4 significantly differed based on admission lactate (p=0.005). Levels of other cytokines studied were not significantly different (p>0.05). Significant differences in hospi tal length of stay (LOS), superficial wound infections (SWI), multisystem organ failure (MSOF) and sepsis/ bacteremia were seen with differing lactate levels. There were no significant differences in mortality amongst groups (p>0.05).
Conclusion: Lactic acidosis in trauma patients may alter peritoneal fluid cytokine levels, specifically IL-4, an anti-inflammatory cytokine that can counteract the pro-inflammatory cascade. Further investigation into the role of lactate as an inflammatory modulator in trauma may provide insight into the local inflammatory response to trauma.
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