Serum Inflammatory Cytokine Markers of Invasive XXXX in Previously Immunocompetent Battle Casualties.

@entity1 @entity5737 @entity146 @entity364 @entity8252 @entity130
BACKGROUND: Invasive @entity364 (IFI) is described increasingly in individuals experiencing high-energy military @entity130 . Hallmarks of successful treatment involve @entity146 and early initiation of systemic antimicrobial therapy. Currently, intravenous anti-fungal therapy commences based on appearance of wounds and @entity1 's clinical course. Whereas some clinical protocols exist to predict which critically injured @entity1 should receive anti-fungal therapies, there are no established serum markers associated with IFI. Our hypothesis is that serum inflammatory cytokines exist that can assist in identifying individuals at risk for IFI. METHODS: This is a retrospective case control study at a single institution. Nine @entity1 with IFI (Saksenaea vasiformis, Fusarium sp., Graphium sp., Scedosporium sp., Aspergillus sp., Mucor sp., and Alternaria sp.) after battlefield @entity130 were matched to nine individuals with similar injury patterns whose laboratory results were negative for IFI. The combination of serum inflammatory cytokines from the first and second debridements was examined with multiplex platform proteomic analysis. We defined statistical significance as a two-tailed a<0.05 after adjusting for multiple comparisons using the false discovery rate method. This model was refined further with correlation-based filter selection and the area under the curve of the receiver operating characteristics (AUROC) was tested. RESULTS: Both groups had similar Injury Severity Scores (ISS) (mean  standard deviation [SD]) (26.8  15.5 vs. 29.2  16.8, p=0.766). Elevated @entity5737 (regulated on activation, normal T cell expressed and secreted) alone (10,492.8  4,450.1 vs. 5,333.3  4,162.2, p=0.006) correlated with IFI. Also, the combination of persistent elevations in @entity5737 , interleukin (IL)-2R, and @entity8252 was a robust model for predicting IFI with the AUROC being 0.9. CONCLUSIONS: Elevation in serum cytokines, particularly @entity5737 , correlated with IFI in this small group of @entity1 . This demonstrates the potential of future rapid serum testing for early initiation and guidance of anti-fungal therapies.
