Endothelial Glycocalyx Degradation Is Associated With Early Organ Impairment in Multiple Trauma Patients

Abstract BackgroundEndothelial glycocalyx (EG) abnormal degradation were widely found in critical illness. However, data of EG degradation in multiple traumas is limited. We performed a study to assess the EG degradation and the correlation between the degradation and organ functions in multiple trauma patients. MethodsA prospective observational study was conducted to enroll health participants (control group) and multiple traumas patients (trauma group) at a University affiliated hospital between Feb 2020 and Oct 2020. Syndecan1 (SDC1) and heparin sulfate (HS) were detected in serum sample of both groups. In trauma group, injury severity scores (ISS) and sequential organ failure assessments (SOFA) were calculated. Occurrences of acute kidney injury (AKI), trauma-induced coagulopathy (TIC) within 48 hours and 28-day all-cause mortality in trauma group were recorded. Serum SDC1 and HS levels were compared between two groups. Correlations between SDC1/HS and the indicators of organ systems in the trauma group were analyzed. ROC analyses were performed to assess the predictive value of SDC1 and HS for AKI, TIC within 48 hours, and 28-day mortality in trauma group. ResultsThere were 45 multiple trauma patients and 15 healthy participants were collected, totally. SDC1 and HS were significantly higher in trauma group than in control group (69.39 [54.18–130.80] vs. 24.15 [13.89–32.36], 38.92 [30.47–67.96] vs. 15.55 [11.89–23.24], P<0.001, respectively). SDC1 and HS were both positively correlated with prothrombin time, activated partial thromboplastin time, EVLW, N-terminal pro-B-type natriuretic peptide, myoglobin, creatinine, lactic acid, interleukin-6, and tumor necrosis factor-α (P<0.05, respectively). SDC1 and HS were both negatively correlated with Ca2+, anti-thrombin-III, PaO2/FiO2 ratio, pH and albumin (P<0.05, respectively). Trauma group was divided into high degradation group and low degradation group according to SDC1 median. High degradation group had more severe ISS, SOFA scores, worse organ functions (respiratory, kidney, coagulation and metabolic system), and higher incidence of hypothermia, acidosis and shock. ROC curve analyses demonstrated SDC1 can predict the occurrence risk of AKI, TIC within 48h, and 28-day mortality. ConclusionsEG degradation was elevated significantly in multiple trauma patients, and the degradation was correlated with impaired respiratory, kidney, coagulation and metabolic systems. Serum SDC1 is a valuable predictive indicator of early TIC, AKI risk, and 28-day mortality in multiple trauma patients.

Download Full-text

Endothelial glycocalyx degradation is associated with early organ impairment in polytrauma patients

BMC Emergency Medicine ◽

10.1186/s12873-021-00446-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Feng Qi ◽

Hao Zhou ◽

Peng Gu ◽

Zhi-He Tang ◽

Bao-Feng Zhu ◽

...

Keyword(s):

Injury Severity ◽

Early Stage ◽

Endothelial Glycocalyx ◽

Control Group ◽

Metabolic System ◽

Metabolic Systems ◽

Organ Systems ◽

Severity Scores ◽

Polytrauma Patients ◽

Trauma Group

Abstract Background Endothelial glycocalyx (EG) abnormal degradation were widely found in critical illness. However, data of EG degradation in multiple traumas is limited. We performed a study to assess the EG degradation and the correlation between the degradation and organ functions in polytrauma patients. Methods A prospective observational study was conducted to enroll health participants (control group) and polytrauma patients (trauma group) at a University affiliated hospital between Feb 2020 and Oct 2020. Syndecan1 (SDC1) and heparin sulfate (HS) were detected in serum sample of both groups. In trauma group, injury severity scores (ISS) and sequential organ failure assessments (SOFA) were calculated. Occurrences of acute kidney injury (AKI), trauma-induced coagulopathy (TIC) within 48 h and 28-day all-cause mortality in trauma group were recorded. Serum SDC1 and HS levels were compared between two groups. Correlations between SDC1/HS and the indicators of organ systems in the trauma group were analyzed. ROC analyses were performed to assess the predictive value of SDC1 and HS for AKI, TIC within 48 h, and 28-day mortality in trauma group. Results There were 45 polytrauma patients and 15 healthy participants were collected, totally. SDC1 and HS were significantly higher in trauma group than in control group (69.39 [54.18–130.80] vs. 24.15 [13.89–32.36], 38.92 [30.47–67.96] vs. 15.55 [11.89–23.24], P < 0.001, respectively). Trauma group was divided into high degradation group and low degradation group according to SDC1 median. High degradation group had more severe ISS, SOFA scores, worse organ functions (respiratory, kidney, coagulation and metabolic system), and higher incidence of hypothermia, acidosis and shock. The area under the receiver operator characteristic curves (AUC) of SDC1 to predict AKI, TIC occurrence within 48 h and 28-day mortality were 0.838 (95%CI: 0.720–0.957), 0.700 (95%CI: 0.514–0.885) and 0.764 (95%CI: 0.543–0.984), respectively. Conclusions EG degradation was elevated significantly in polytrauma patients, and the degradation was correlated with impaired respiratory, kidney, coagulation and metabolic systems in early stage. Serum SDC1 is a valuable predictive indicator of early onset of AKI, TIC, and 28-day mortality in polytrauma patients.

Download Full-text

EARLY PROBIOTICS IN PREVENTING VENTILATOR-ASSOCIATED PNEUMONIA AFTER MULTIPLE TRAUMA

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2020.v13i10.38114 ◽

2020 ◽

pp. 83-85

Author(s):

TAMER HABIB ◽

AMIRA B KASSEM ◽

ISLAM AHMED

Keyword(s):

Multiple Trauma ◽

University Hospital ◽

Control Group ◽

Trauma Patients ◽

Ventilator Associated Pneumonia ◽

Mechanically Ventilated ◽

Significant Difference ◽

Multiple Trauma Patients ◽

And Control

Objective: Using probiotics in preventing ventilator-associated pneumonia (VAP) remain controversial due to different intensive care unit (ICU) populations included in such studies. The aim of this study is to evaluate the role of probiotics in prophylaxis of VAP after multiple trauma. Methods: Sixty-five adult multiple trauma patients on mechanical ventilator (expected ≥48 h) after admission to the Critical Care Medicine Department, Alexandria Main University Hospital from June to November 2018. Patients were randomly assigned using computer sheet into two groups; probiotics group (32 patients received one Lacteol Forte® sachet through orogastric/nasogastric tube 3 times daily during their ICU stay) and control group (33 patients received similar regimen of placebo sachets). All patients were followed up and subjected to all possible strategies of the diagnosis of microbiologically confirmed VAP. Results: Sixty-five patients were enrolled with a mean of age (39.48±7.692) years, 80% of them were male. Regarding the incidence of VAP, it was 18.46% of all patients without statistically significant difference between probiotics group (15.63%) and control group (21.21%) (p=0.751). Conclusion: Routine use of early probiotics in mechanically ventilated multiple trauma patients was not associated with lower incidence of VAP, duration of MV, or ICU mortality.

Download Full-text

Comparison of Trauma Severity Scores (ISS, NISS, RTS, BIG Score, and TRISS) in Multiple Trauma Patients

Journal of Trauma Nursing ◽

10.1097/jtn.0000000000000567 ◽

2021 ◽

Vol 28 (2) ◽

pp. 100-106

Author(s):

Mehmet Hilmi Höke ◽

Eren Usul ◽

Seda Özkan

Keyword(s):

Multiple Trauma ◽

Trauma Patients ◽

Trauma Severity ◽

Severity Scores ◽

Multiple Trauma Patients

Download Full-text

Have Severity Scores a Place in Predicting Septic Complications in ICU Multiple Trauma Patients?

The Journal of Critical Care Medicine ◽

10.1515/jccm-2016-0023 ◽

2016 ◽

Vol 2 (3) ◽

pp. 107-108

Author(s):

Daniela Ionescu

Keyword(s):

Multiple Trauma ◽

Trauma Patients ◽

Septic Complications ◽

Severity Scores ◽

Multiple Trauma Patients

Download Full-text

Can APACHE II, SOFA, ISS, and RTS Severity Scores be Used to Predict Septic Complications in Multiple Trauma Patients?

The Journal of Critical Care Medicine ◽

10.1515/jccm-2016-0019 ◽

2016 ◽

Vol 2 (3) ◽

pp. 124-130 ◽

Cited By ~ 5

Author(s):

Sebastian Trancă ◽

Cristina Petrișor ◽

Natalia Hagău ◽

Constantin Ciuce

Keyword(s):

Multiple Trauma ◽

Infectious Complications ◽

Apache Ii ◽

Cutoff Score ◽

Trauma Patients ◽

Septic Complications ◽

Kaplan Meier ◽

Severity Scores ◽

Multiple Trauma Patients ◽

Composite Scores

Abstract Background: Physiological composite scores are used to predict mortality in multiple trauma patients. Sepsis is the leading cause of late mortality in trauma victims brought about by immune suppression due to homeostasis dysregulation. Objective: To determine whether APACHE II, SOFA, ISS and RTS scores can predict the occurrence of sepsis in multiple trauma patients. Methods: APACHE II, SOFA, ISS, and RTS scores were calculated during the first twenty-four hours after the injury for sixty-four adult poly-traumatic patients. The occurrence of infectious complications was investigated over a fourteenday period. The infection-free rates for the multiple trauma patients were considered as end-points in the Kaplan- Meier plot analysis. Results: For SOFA, a cutoff score of 4 points was identified as a predictor of the occurrence of sepsis, with 89% of the patients with SOFA<4 being infection-free, while 37% of those with SOFA>4 were infection-free (p<0.01). None of the patients with APACHE II≤5 points developed infections. Eighty-four percent of patients with APACHE II scores of 5-10 did not develop sepsis, while 49% with APACHE II≥11 were infection-free (p<0.01). A cutoff of 7 points was found to be most discriminative for RTS. Eighty-eight percent of the patients with RTS≥7 and 43% of those with RTS<7 were infection-free (p<0.01). Eighty-eight percent of patients with ISS<22 did not develop sepsis and 56% with ISS≥22 did not develop sepsis (p<0.01). Conclusion: APACHE II, SOFA, ISS, and RTS functional severity scores can predict mortality as well as the occurrence of sepsis in multiple trauma patients.

Download Full-text

The potential of adipokines in identifying multiple trauma patients at risk of developing multiple organ dysfunction syndrome

European Journal of Medical Research ◽

10.1186/s40001-021-00511-z ◽

2021 ◽

Vol 26 (1) ◽

Author(s):

Julian Haupt ◽

Niels Krysiak ◽

Marina Unger ◽

Viktoria Bogner-Flatz ◽

Peter Biberthaler ◽

...

Keyword(s):

Multiple Trauma ◽

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Plasma Concentrations ◽

Multiple Organ ◽

Control Group ◽

Trauma Patients ◽

Multiple Organ Dysfunction ◽

Patients At Risk ◽

Multiple Trauma Patients

Abstract Background Multiple organ dysfunction syndrome (MODS) and the consecutive multiple organ failure (MOF) are severe and dreaded complications with a high mortality in multiple trauma patients. The aim of this study was to investigate the potential of the adipokines leptin, resistin, interleukin-17A and interleukin-33 as possible biomarkers in the early posttraumatic inflammatory response and for identifying severely traumatized patients at risk of developing MODS. Methods In total, 14 multiple trauma patients with an injury severity score (ISS) ≥ 16 as well as a control group of 14 non-multiple trauma patients were included in this study and blood samples were taken at the time points 0, 6, 24, 48 and 72 h after admission. For the trauma patients, the SIRS and Denver MOF score were determined daily. The quantitative measurement of the plasma concentrations of the adipokines was performed using ELISA. Results In the statistical analysis, the multiple trauma patients showed statistically significant higher plasma concentrations of leptin, resistin, IL-17A and IL-33 compared to the control group. In addition, there was a statistically significant positive correlation between the concentrations of resistin, IL-17A and IL-33 and the corresponding SIRS scores and between the concentrations of resistin, IL-17A and IL-33 and the corresponding Denver MOF scores. Finally, ROC curve analysis revealed that the adipokines leptin and IL-17A are suitable diagnostic markers for the discrimination between multiple trauma patients with and without MOF. Conclusions Leptin and IL-17A could be suitable diagnostic markers to identify severely injured patients with a developing SIRS and MOF earlier, to adjust surgical therapy planning and intensive care.

Download Full-text

The Potential of Adipokines in Identifying Multiple Trauma Patients at Risk of Developing Multiple Organ Dysfunction Syndrome

10.21203/rs.3.rs-92157/v1 ◽

2020 ◽

Author(s):

Julian Haupt ◽

Niels Krysiak ◽

Marina Unger ◽

Viktoria Bogner-Flatz ◽

Peter Biberthaler ◽

...

Keyword(s):

Multiple Trauma ◽

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Plasma Concentrations ◽

Multiple Organ ◽

Control Group ◽

Trauma Patients ◽

Multiple Organ Dysfunction ◽

Patients At Risk ◽

Multiple Trauma Patients

Abstract BackgroundMultiple organ dysfunction syndrome (MODS) and the consecutive multiple organ failure (MOF) are severe and dreaded complications with a high mortality in multiple trauma patients. The aim of this study was to investigate the potential of the adipokines leptin, resistin, interleukin-17A and interleukin-33 as possible biomarkers in the early posttraumatic inflammatory response and for identifying severely traumatized patients at risk of developing MODS.MethodsIn total, 14 multiple trauma patients with an injury severity score (ISS) ³ 16 as well as a control group of 14 non-multiple trauma patients were included in this study and blood samples were taken at the time points 0, 6, 24, 48 and 72h after admission. For the trauma patients, the SIRS and Denver MOF score were determined daily. The quantitative measurement of the plasma concentrations of the adipokines was performed using ELISA. ResultsIn the statistical analysis, the multiple trauma patients showed statistically significant higher plasma concentrations of leptin, resistin, IL-17A and IL-33 compared to the control group. In addition, there was a statistically significant positive correlation between the concentrations of resistin, IL-17A and IL-33 and the corresponding SIRS scores and between the concentrations of resistin, IL-17A and IL-33 and the corresponding Denver MOF scores. Finally, ROC curve analysis revealed that the adipokines leptin and IL-17A are suitable diagnostic markers for the discrimination between multiple trauma patients with and without MOF. ConclusionsThe results of this study may contribute to identify severely injured patients with a developing SIRS and MOF earlier, in order to adjust therapy strategies.

Download Full-text