Citation Information :
Gupta A, Soni K D, Aggrawal R. Bronchoalveolar lavage fluid cytokine bead array profile for prognostication of ventilated trauma patients. Indian J Crit Care Med 2016; 20 (9):513-517.
Aim of Study: Ventilator-associated pneumonia (VAP) is a common cause of mortality in trauma patients admitted to Intensive Care Units. The outcome of such patients may be dependent on local host immune response, which may be best reflected in studies using bronchoalveolar lavage (BAL) fluid. The present study was conducted to ascertain the cytokine profile of BAL using the cytometric bead array (CBA) in a flow cytometer and to correlate the levels of Th-1/Th-2 cytokines in BAL with the clinical outcome of ventilated trauma patients.
Patients and Methods: BAL was collected from the patients with suspected VAP. CBA was performed to assess the levels of interleukin-4 (IL-4), IL-6, IL-8, IL-1 β, interferon gamma (IFN-γ), and tumor necrosis factor-alpha in the BAL samples. After acquiring the BAL samples on the flow cytometer, the results were generated using FCAP Array™ software. The cytokine profile was correlated to clinical outcomes.
Results: A total of forty patients were enrolled during the study period. Of these, 12 patients (30%) had confirmed VAP and 8 (20%) patients had a fatal outcome. The levels of IL-8 and IFN-γ correlated significantly with the development of VAP and elevated IL-6 in BAL was associated with a poor outcome.
Conclusion: A proinflammatory response in the form of elevated IL-6 and IL-8 correlated poorly with the clinical outcome. Th-1 response was significantly reduced in patients with VAP. A proinflammatory response in the form of elevated IL-6 and IL-8 correlated poorly with the clinical outcome.
Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R; CDC; Healthcare Infection Control Practices Advisory Committee. Guidelines for preventing health-care – Associated pneumonia, 2003: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2004;53:1-36.
Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002;165:867-903.
Baker AM, Meredith JW, Haponik EF. Pneumonia in intubated trauma patients. Microbiology and outcomes. Am J Respir Crit Care Med 1996;153:343-9.
Fagon JY, Chastre J, Hance AJ, Montravers P, Novara A, Gibert C. Nosocomial pneumonia in ventilated patients: A cohort study evaluating attributable mortality and hospital stay. Am J Med 1993;94:281-8.
Rello J, Ollendorf DA, Oster G, Vera-Llonch M, Bellm L, Redman R, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002;122:2115-21.
Costabel U, Guzman J. Bronchoalveolar lavage in interstitial lung disease. Curr Opin Pulm Med 2001;7:255-61.
Tøndell A, Moen T, Børset M, Salvesen O, Rø AD 2nd, Sue-Chu M. Bronchoalveolar lavage fluid IFN-γ+ Th17 cells and regulatory T cells in pulmonary sarcoidosis. Mediators Inflamm 2014;2014:1-9.
Batra P, Mathur P, John NV, Nair SA, Aggarwal R, Soni KD, et al. Impact of multifaceted preventive measures on ventilator-associated pneumonia at a single surgical centre. Intensive Care Med 2015;41:2231-2.
Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309-32.
Collee JG, Diguid JP, Fraser AG, editors. Mackie and McCartney Practical Medical Microbiology. 14th ed. Edinburgh: Churchill Livingstone; 1996.
Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. 16th Informational Supplements, M100-S16. CLSI 2006. Wayne, PA, USA: Clinical and Laboratory Standards Institute; 2006.
Lalwani S, Mathur P, Tak V, Janani S, Kumar SI, Bagla R, et al. Diagnosis of ventilator-associated pneumonia: Comparison between ante-mortem and post-mortem cultures in trauma patients. Indian J Med Microbiol 2014;32:294-300.
Khurana S, Mathur P, Batra P, Nair SA, Varghese P, John NV, et al. Does Infection with Multidrug Resistant Bacteria Necessarily Lead to Adverse Patient Outcome? A Prospective Study. Abstract Presented in 15th Congress of International Federation of Infection Control, XIII National Conference of Hospital Infection Society, 21-24 March, 2015, New Delhi, India; 2015.
Urbankowski T, Hoser G, Domagala-Kulawik J. Th1/Th2/Th17-related cytokines in the bronchoalveolar lavage fluid of patients with sarcoidosis: Association with smoking. Pol Arch Med Wewn 2012;122:320-5.
Mortaz E, Gudarzi H, Tabarsi P, M Adcock I, Masjedi MR, Jamaati HR, et al. Flow cytometry applications in the study of immunological lung disorders. Iran J Allergy Asthma Immunol 2015;14:12-8.
Boomer JS, Parulekar AD, Patterson BM, Yin-Declue H, Deppong CM, Crockford S, et al. A detailed phenotypic analysis of immune cell populations in the bronchoalveolar lavage fluid of atopic asthmatics after segmental allergen challenge. Allergy Asthma Clin Immunol 2013;9:37.