Does Scheduled Low-Dose Short-Term NSAID (Ketorolac) Modulate Cytokine Levels After Orthopaedic Polytrauma? A Secondary Analysis of a Randomized Clinical Trial.

IF 1.6 3区医学 Q3 ORTHOPEDICS Journal of Orthopaedic Trauma Pub Date : 2024-07-01 DOI:10.1097/BOT.0000000000002807

Jeffrey A Foster, Gregory S Hawk, David C Landy, Jarod T Griffin, Andrew C Bernard, Douglas R Oyler, Wyatt G S Southall, Maaz Muhammad, Carlos R Sierra-Arce, Samuel D Mounce, Jacob S Borgida, Lusha Xiang, Arun Aneja

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Abstract

Objectives: To determine whether scheduled low-dose, short-term ketorolac modulates cytokine concentrations in orthopaedic polytrauma patients.

Methods:

Design: Secondary analysis of a double-blinded, randomized controlled trial.

Setting: Single Level I trauma center from August 2018 to October 2022.

Patient selection criteria: Orthopaedic polytrauma patients between 18 and 75 years with a New Injury Severity Score greater than 9 were enrolled. Participants were randomized to receive 15 mg of intravenous ketorolac every 6 hours for up to 5 inpatient days or 2 mL of intravenous saline similarly.

Outcome measures and comparisons: Daily concentrations of prostaglandin E2 and interleukin (IL)-1a, IL-1b, IL-6, and IL-10. Clinical outcomes included hospital and intensive care unit length of stay, pulmonary complications, and acute kidney injury.

Results: Seventy orthopaedic polytrauma patients were enrolled, with 35 participants randomized to the ketorolac group and 35 to the placebo group. The overall IL-10 trend over time was significantly different in the ketorolac group ( P = 0.043). IL-6 was 65.8% higher at enrollment compared to day 3 ( P < 0.001) when aggregated over both groups. There was no significant treatment effect for prostaglandin E2, IL-1a, or IL-1b ( P > 0.05). There were no significant differences in clinical outcomes between groups ( P > 0.05).

Conclusions: Scheduled low-dose, short-term, intravenous ketorolac was associated with significantly different mean trends in IL-10 concentration in orthopaedic polytrauma patients with no significant differences in prostaglandin E2, IL-1a, IL-1b, or IL-6 levels between groups. The treatment did not have an impact on clinical outcomes of hospital or intensive care unit length of stay, pulmonary complications, or acute kidney injury.

Level of evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

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计划性低剂量短期非甾体抗炎药（Ketorolac）能否调节骨科多发性创伤后的细胞因子水平？一项随机临床试验的二次分析。

目的确定计划中的低剂量、短期酮咯酸是否会调节骨科多发性创伤患者的细胞因子浓度：方法：设计：双盲随机对照试验的二次分析：2018年8月至2022年10月单个一级创伤中心.患者选择标准：年龄在 18-75 岁之间、新伤严重程度评分大于 9 分的骨科多发创伤患者入选。参与者被随机分配接受每 6 小时静脉注射 15 毫克酮咯酸，最多 5 个住院日，或同样接受 2 毫升静脉注射生理盐水：前列腺素 E2 (PGE2)、白细胞介素 (IL)-1a、IL-1b、IL-6 和 IL-10 的每日浓度。临床结果包括住院时间和重症监护室（ICU）时间、肺部并发症和急性肾损伤（AKI）：70名骨科多发性创伤患者参加了研究，其中35人被随机分配到酮咯酸组，35人被随机分配到安慰剂组。随着时间的推移，IL-10的总体趋势在酮咯酸组有显著差异（p = 0.043）。两组的总IL-6在入组时比第3天高65.8%（p < 0.001）。PGE2、IL-1a 或 IL-1b 的治疗效果不明显（p > 0.05）。两组的临床结果无明显差异（P > 0.05）：结论：在骨科多发性创伤患者中，计划的低剂量、短期静脉注射酮咯酸与IL-10浓度的平均趋势显著不同相关，而PGE2、IL-1a、IL-1b或IL-6水平在组间无显著差异。该疗法对住院或重症监护室生存期、肺部并发症或 AKI 等临床结果没有影响：有关证据等级的完整描述，请参阅 "作者须知"。

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来源期刊

Journal of Orthopaedic Trauma 医学-运动科学

CiteScore

3.90

自引率

8.70%

发文量

396

审稿时长

3-8 weeks

期刊介绍： Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.