Inflammatory cytokines and neurotrauma biomarkers are acutely elevated in military combat casualties and predict resource use
- 1Center for Inflammation Science and Systems Medicine, University of Florida Scripps Research Institute, Jupiter, FL, United States
- 2US Army Burn Center, US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States
- 3Department of Expeditionary Critical Care Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States
Abstract
Introduction:: Triage of and evacuation decisions for military service members deployed into combat zones experiencing traumatic injuries are serious challenges for military medical providers. We explored the utility of inflammatory biomarkers in determining injury severity and predicting hospital resource utilization to improve the effectiveness of casualty care.
Methods:: Serum levels of inflammatory cytokines (eNAMPT, IL-6, PSGL-1, ANG-2, IL-1β, IL-1RA, TNF-α, and S100A8) and neurotrauma biomarkers (GFAP, NfL, and tau) were analyzed in trauma-exposed warfighters (n = 39) evacuated to a medical treatment facility. Prior to analysis, outliers were removed via robust regression and outlier removal, with the results analyzed using the Mann–Whitney test, Kruskal–Wallis test w/ Dunn, or Spearman correlation.
Results:: All the tested biomarkers were significantly elevated (p < 0.0001) in combat casualties vs. healthy controls (n = 46) and exhibited injury type-specific elevations. Serum eNAMPT (p = 0.033) and TNF-α (p = 0.047) were significantly higher in penetrating wounds vs. blunt trauma; IL-1β (p = 0.005) and S100A8 (p = 0.005) were significantly elevated in thermal injures vs. blunt trauma; and GFAP (p < 0.001) and NfL (p = 0.017) were significantly elevated in blunt trauma vs. thermal injury. Statistical correlations between biomarkers and clinical outcomes indicated the following: (i) duration of mechanical ventilatory support correlated with IL-1RA level (p = 0.021); (ii) duration of hospital stay correlated with IL-6 (p = 0.016) and eNAMPT levels (p = 0.046); and (iii) duration of ICU stay correlated with eNAMPT (p = 0.016) and S100A8 (p = 0.017) levels.
Conclusions:: Our results extend prior reports of innate immune activation following traumatic injury and suggest a diverse panel of inflammatory biomarkers may predict hospital resource utilization to inform prioritization of local resources and evacuation to higher levels of care.
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BibTeX
@article{johnson2026inflammatory,
title = {{Inflammatory cytokines and neurotrauma biomarkers are acutely elevated in military combat casualties and predict resource use}},
author = {Nathan H. Johnson and Nancy G. Casanova and Sara M. Camp and Leopoldo Cancio and Yansong Li and Joe G. N. Garcia},
journal = {Frontiers in disaster and emergency medicine},
year = {2026},
month = aug,
doi = {10.3389/femer.2026.1906777},
url = {https://doi.org/10.3389/femer.2026.1906777},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Inflammatory cytokines and neurotrauma biomarkers are acutely elevated in military combat casualties and predict resource use
AU - Nathan H. Johnson
AU - Nancy G. Casanova
AU - Sara M. Camp
AU - Leopoldo Cancio
AU - Yansong Li
AU - Joe G. N. Garcia
PY - 2026
DA - 2026/08/16
JO - Frontiers in disaster and emergency medicine
DO - 10.3389/femer.2026.1906777
UR - https://doi.org/10.3389/femer.2026.1906777
AB - Introduction:: Triage of and evacuation decisions for military service members deployed into combat zones experiencing traumatic injuries are serious challenges for military medical providers. We explored the utility of inflammatory biomarkers in determining injury severity and predicting hospital resource utilization to improve the effectiveness of casualty care. Methods:: Serum levels of inflammatory cytokines (eNAMPT, IL-6, PSGL-1, ANG-2, IL-1β, IL-1RA, TNF-α, and S100A8) and neurotrauma biomarkers (GFAP, NfL, and tau) were analyzed in trauma-exposed warfighters (n = 39) evacuated to a medical treatment facility. Prior to analysis, outliers were removed via robust regression and outlier removal, with the results analyzed using the Mann–Whitney test, Kruskal–Wallis test w/ Dunn, or Spearman correlation. Results:: All the tested biomarkers were significantly elevated (p < 0.0001) in combat casualties vs. healthy controls (n = 46) and exhibited injury type-specific elevations. Serum eNAMPT (p = 0.033) and TNF-α (p = 0.047) were significantly higher in penetrating wounds vs. blunt trauma; IL-1β (p = 0.005) and S100A8 (p = 0.005) were significantly elevated in thermal injures vs. blunt trauma; and GFAP (p < 0.001) and NfL (p = 0.017) were significantly elevated in blunt trauma vs. thermal injury. Statistical correlations between biomarkers and clinical outcomes indicated the following: (i) duration of mechanical ventilatory support correlated with IL-1RA level (p = 0.021); (ii) duration of hospital stay correlated with IL-6 (p = 0.016) and eNAMPT levels (p = 0.046); and (iii) duration of ICU stay correlated with eNAMPT (p = 0.016) and S100A8 (p = 0.017) levels. Conclusions:: Our results extend prior reports of innate immune activation following traumatic injury and suggest a diverse panel of inflammatory biomarkers may predict hospital resource utilization to inform prioritization of local resources and evacuation to higher levels of care.
SN - 2813-7302
ER -