Immunoparalysis in patients with severe trauma and the effect of inhaled interferon-γ*

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Abstract
Objective To evaluate the local immune status in patients with severe trauma and the influence of interferon-γ on patients with immunoparalysis. Patients Fifty-two mechanically ventilated patients with severe multiple trauma. Setting A 14-bed polyvalent intensive care unit. Interventions The local immune status was evaluated by examining bronchoalveolar lavage fluid. Subsequently, the patients were divided into two groups: immunoparalyzed (group 1) and nonimmunoparalyzed (group 2). Immunoparalysis was defined as a decreased level of human leukocyte antigen-DR expression of alveolar macrophages in 2, interleukin-1β, platelet-aggregating factor acetylhydrolase, and interleukin-10, were evaluated in the bronchoalveolar lavage fluids. Results In 21 of 52 (40%) patients, immunoparalysis was established. After interferon-γ administration, the level of human leukocyte antigen-DR expression increased in group 1a from 17 ± 5% to 46 ± 9%. In parallel, platelet-aggregating factor and interleukin-1β as well as the specific activities of phospholipase A2 and platelet-aggregating factor acetylhydrolase significantly increased. In contrast, interleukin-10 decreased after interferon-γ therapy. In group 1b, no statistically significant changes appeared in the levels of human leukocyte antigen-DR expression or in the concentrations of inflammatory mediators. The incidence of ventilator-associated pneumonia was significantly lower in group 1a than in group 1b. The administration of interferon-γ did not affect the outcome of the patients. Conclusions A significant proportion of multiply injured patients developed immunoparalysis. The administration of interferon-γ resulted in the recovery of levels of human leukocyte antigen-DR expression in alveolar macrophages, influenced the inflammatory reaction, and decreased the incidence ventilator-associated pneumonia, without affecting the patients’ outcome.