IMPACT OF ACUTE, SUB-ACUTE AND CHRONIC ALCOHOL CONSUMPTION ON THE DANGER RESPONSE AFTER EXPERIMENTAL AND CLINICAL TRAUMA

Sandra HelinskiLeave a Comment

Relja B1, Wagner N1, Mörs K1, Marzi I1
1Department of Trauma, Hand and Reconstructive Surgery, University Hospital
of the Goethe-University Frankfurt, Frankfurt am Main, Germany

The influence of alcohol on the immune response and outcome after trauma
remains controversial. Increased levels of pro-inflammatory cytokines and
leukocyte infiltration into tissues are closely linked to harmful local and systemic
inflammation leading to organ damage after trauma. Recent studies have shown
(neuro)protective effects while others reported negative or no effects of alcohol in
trauma patients (TP) or in animal trauma models.
Therefore, we evaluated time-dependent effects of alcohol-consumption on local
(liver) and systemic immune response in in-vivo trauma models and TP.
In the chronic alcohol model mice were fed a Lieber-DeCarli diet containing
alcohol for 4 weeks. Local and systemic inflammation, NF-κB activation and
hepatic injury were increased by alcohol after hemorrhagic shock and
resuscitation (H/R).
In contrast, in a sub-acute model of alcohol-consumption, in which rats were
given a single oral dose of ethanol (5g/kg, 30%) 12-16h before H/R, alcohol
suppressed both, local and systemic pro-inflammatory changes, NF-κB activity
after H/R and decreased mortality at 72h.
In order to further characterize the “beneficial” effects of sub-acute alcoholconsumption,
trauma severity was increased by inducing a blunt chest trauma
(TxT) before H/R. Here, sub-acute alcohol (12h) prior TxT+H/R was neither
beneficial nor unfavorable. However, applying alcohol acutely (2h) before
TxT+H/R induced detrimental effects with regard to liver damage and systemic
inflammation.
In a clinical study, TP were grouped according to positive blood alcohol
concentration (>0.5‰, BAC+, n=49) vs. <0.5‰ alcohol (BAC-, n=135) upon
admission and systemic cytokines were determined. Injury severity, age, (multi)
organ failure, SIRS, sepsis, pneumonia, ARDS and in-hospital mortality were not
statistically different. BAC+ significantly decreased leukocyte numbers and
systemic IL-6 compared to BAC-. While there was a significant positive
correlation between leukocyte counts and IL-6 as well as BAC and leukocytes,
BAC levels did not correlate with IL-6.
Summarized, alcohol provokes different immune responses to experimental
trauma depending on trauma severity and timing of intoxication. Acute alcohol
opposed to sub-acute alcohol-consumption appeared rather deleterious after
trauma.
Moreover, positive BAC was associated with reduced leukocytes and systemic
IL-6at admittance to emergency department indicating immune-suppressive
effects.

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