THE IMPACTS OF ALCOHOL ACUTE INTOXICATION IN THE IMMUNE RESPONSE AND THE DEVELOPMENT OF INFECTIONS IN TRAUMA PATIENTS.
Name: Priscilla de Aquino Martins
Type: MSc dissertation
Publication date: 21/06/2018
Advisor:
Name |
Role |
|---|---|
| CLAUDIO PIRAS | Advisor * |
Examining board:
| Name |
Role |
|---|---|
| CLAUDIO PIRAS | Advisor * |
| Ester Miyuki Nakamura Palacios | Internal Examiner * |
Summary: Introduction: The association alcohol and trauma is already well stabilished. Trauma victims, in brazilian main cities, are found alcoholic in 16,3% of the accidents. Studies have shown the relation between alcohol effects and the inflammatory response and have tried to correlate these effects to infection and survival, in trauma victims. However, these results are controversial e most of them were made using animals models. Objectives: Evaluate if the alcohol acute intoxication reduces interleukin(IL) 6 levels (pro-inflammatory cytokine) and increases interleukin 10 levels (anti-inflammatory cytokine) in trauma victims and correlate acute alcohol intoxication with infection development and mortality. Methods: Observational prospective cohort study in severe trauma victims patients admitted in the emergency of a public trauma reference hospital up to 12 hours after trauma occurrence. Blood and/or urine were tested for alcohol and were considered positives when alcohol levels was > 5mg/dl in blood or > 50mg/dl in urine. Patients were followed up during seven days for infection development and death. 115 patients were included. Patients were divided in two groups: alcohol group (n=32) and control group (n=83). It was possible to dose inteukins in 43 patients, of which 32 showed negative alcohol levels (control group) and on 11 the alcohol levels were positive (alcohol group). Results: Infection development occurred in 31,25% of the alcohol group individuals and in 46,99% of control group (p=0.145). Death was observed in 12,5% of the alcohol group individuals and in 16,87% of control group (p=0.591). The alcohol association with infection development had an OR=0.414 (95% IC = 0.159 1.076) and the association with death an OR= 0.548 (95% IC= 0.149 2.010). The IL6 was elevated on 100% of the individuals of alcohol group and in control group it was over the normal levels in less than 2/3 of the individuals at admission (p=0.041). In 48 hours IL6 has found still elevated in both groups. IL10 was elevated in more individuals in control group than in alcohol group at admission and in48h was normalized in most of the patients in both groups. It didnt observed association of alcohol with elevated interleukin levels when applied multiple logistic regression. However, in alcohol group it´s possible to see an elevated IL6 at admission in all patients and in 48h a protection on this elevation, OR was 0.300 (95% CI= 0.037 2.442), for IL10 elevated at admission OR=0.629 (95% CI = 0.156 2.531) and for IL10 at 48 hours OR=0.489 (95% CI=0.089 2.689). Conclusion: Alcohol is associated with less infections and mortality in trauma victims. It seems to protect individuals from elevations in IL10 in first 48 hours and from prolonged elevations in IL6 after trauma.
Keywords: Alcohol. Trauma. Interleukin. Infection.
