Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Significance of Biomarkers as a Predictive Factor for Post-Traumatic Sepsis

  • Lee, Kyung-Wuk (Department of Emergency Medicine, College of Medicine, Korea University) ;
  • Choi, Sung-Hyuk (Department of Emergency Medicine, College of Medicine, Korea University) ;
  • Yoon, Young-Hoon (Department of Emergency Medicine, College of Medicine, Korea University) ;
  • Kim, Jung-Youn (Department of Emergency Medicine, College of Medicine, Korea University) ;
  • Cho, Young-Duck (Department of Emergency Medicine, College of Medicine, Korea University) ;
  • Cho, Han-Jin (Department of Emergency Medicine, College of Medicine, Korea University) ;
  • Park, Sung-Jun (Department of Emergency Medicine, Korean Armed Forces Capital Hospital)
  • Received : 2018.07.23
  • Accepted : 2018.09.26
  • Published : 2018.12.31
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Abstract

Purpose: Many traumatic patients die from sepsis and multiple organ failure. Early recognition of post-traumatic sepsis in traumatic patients will help improve the prognosis. Recently, procalcitonin (PCT), macrophage migration inhibitory factor (MIF), and lactic acid have emerged as predictive factors. Our study aims to explore the significance of PCT, MIF and lactic acid as a predictor of posttraumatic-sepsis in trauma patients. Methods: This study was conducted on prospective observational study patients who visited an emergency medical center in a university hospital from March 2014 to February 2016. We measured the white blood cells, c-reactive protein (CRP), lactic acid, PCT, and MIF with serum taken from the patient's blood within 1 hour of the occurrence of the trauma. The definition of post-traumatic sepsis was defined as being part of systemic inflammation response syndrome criteria with infections within a week. Results: A total of 132 patients were analyzed, wherein 74 patients were included in the low injury severity score (ISS) group (ISS <15) and 58 patients were included in the high ISS group (ISS ${\geq}15$). The mean PCT, MIF, and lactic acid levels were higher in the high ISS group (p<0.05). Meanwhile, 38 patients were included in the early sepsis group and 94 patients were included in the non-sepsis group. The mean MIF levels were higher in the sepsis group than the non-sepsis group (p<0.05) and there were no significant differences in the initial CRP, lactic acid, and PCT levels in these two groups. Conclusions: MIF may be considered as a predictive factor for sepsis in trauma patients.

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References

  1. Trunkey DD. Trauma. Accidental and intentional injuries account for more years of life lost in the U.S. than cancer and heart disease. Among the prescribed remedies are improved preventive efforts, speedier surgery and further research. Sci Am 1983;249:28-35. https://doi.org/10.1038/scientificamerican0883-28
  2. Bernhagen J, Calandra T, Bucala R. Regulation of the immune response by macrophage migration inhibitory factor: biological and structural features. J Mol Med (Berl) 1998;76:151-61. https://doi.org/10.1007/s001090050204
  3. Slade E, Tamber PS, Vincent JL. The Surviving Sepsis Campaign: raising awareness to reduce mortality. Crit Care 2003;7:1-2.
  4. Park JH, Choi SH, Yoon YH, Park SJ, Kim JY, Cho HJ. Risk factors for sepsis in Korean trauma patients. Eur J Trauma Emerg Surg 2016;42:453-8. https://doi.org/10.1007/s00068-015-0552-6
  5. Rajkumari N, Mathur P, Sharma S, Gupta B, Bhoi S, Misra MC. Procalcitonin as a predictor of sepsis and outcome in severe trauma patients: a prospective study. J Lab Physicians 2013;5:100-8. https://doi.org/10.4103/0974-2727.119852
  6. Cho YD, Choi SH, Kim JY, Park SJ, Yoon YH, Cho HJ, et al. Macrophage migration inhibitory factor levels correlate with an infection in trauma patients. Ulus Travma Acil Cerrahi Derg 2017;23:193-8.
  7. Bone RC. Let's agree on terminology: definitions of sepsis. Crit Care Med 1991;19:973-6. https://doi.org/10.1097/00003246-199107000-00024
  8. Annane D, Bellissant E, Cavaillon JM. Septic shock. Lancet 2005;365:63-78. https://doi.org/10.1016/S0140-6736(04)17667-8
  9. Becker JU, Theodosis C, Jacob ST, Wira CR, Groce NE. Surviving sepsis in low-income and middle-income countries: new directions for care and research. Lancet Infect Dis 2009;9:577-82. https://doi.org/10.1016/S1473-3099(09)70135-5
  10. Mimoz O, Benoist JF, Edouard AR, Assicot M, Bohuon C, Samii K. Procalcitonin and C-reactive protein during the early posttraumatic systemic inflammatory response syndrome. Intensive Care Med 1998;24:185-8. https://doi.org/10.1007/s001340050543
  11. Becker KL, Nylen ES, White JC, Muller B, Snider RH Jr. Clinical review of 167: procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors. J Clin Endocrinol Metab 2004;89:1512-25. https://doi.org/10.1210/jc.2002-021444
  12. Bernhagen J, Krohn R, Lue H, Gregory JL, Zernecke A, Koenen RR, et al. MIF is a noncognate ligand of CXC chemokine receptors in inflammatory and atherogenic cell recruitment. Nat Med 2007;13:587-96. https://doi.org/10.1038/nm1567
  13. Schober A, Bernhagen J, Weber C. Chemokine-like functions of MIF in atherosclerosis. J Mol Med (Berl) 2008;86:761-70. https://doi.org/10.1007/s00109-008-0334-2
  14. Calandra T, Roger T. Macrophage migration inhibitory factor: a regulator of innate immunity. Nat Rev Immunol 2003;3:791-800. https://doi.org/10.1038/nri1200
  15. Froidevaux C, Roger T, Martin C, Glauser MP, Calandra T. Macrophage migration inhibitory factor and innate immune responses to bacterial infections. Crit Care Med 2001;29(7 Suppl):S13-5. https://doi.org/10.1097/00003246-200107001-00006
  16. Bozza M, Satoskar AR, Lin G, Lu B, Humbles AA, Gerard C, et al. Targeted disruption of migration inhibitory factor gene reveals its critical role in sepsis. J Exp Med 1999;189:341-6. https://doi.org/10.1084/jem.189.2.341
  17. Levy B. Lactate and shock state: the metabolic view. Curr Opin Crit Care 2006;12:315-21. https://doi.org/10.1097/01.ccx.0000235208.77450.15
  18. Bakker J, Gris P, Coffernils M, Kahn RJ, Vincent JL. Serial blood lactate levels can predict the development of multiple organ failure following septic shock. Am J Surg 1996;171:221-6. https://doi.org/10.1016/S0002-9610(97)89552-9
  19. Shin TG, Hwang SY, Kang GH, Kim WY, Ryoo SM, Kim K, et al. Korean Shock Society septic shock registry: a preliminary report. Clin Exp Emerg Med 2017;30:146-53.