Johansson Pär I, Henriksen Hanne H, Stensballe Jakob, Gybel-Brask Mikkel, Cardenas Jessica C, Baer Lisa A, Cotton Bryan A, Holcomb John B, Wade Charles E, Ostrowski Sisse R
*Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark †Department of Surgery, Centre for Translational Injury Research, UT Health, University of Texas Health Science Center at Houston, Houston, TX ‡Department of Anesthesia, Centre of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Ann Surg. 2017 Mar;265(3):597-603. doi: 10.1097/SLA.0000000000001751.
Investigate and confirm the association between sympathoadrenal activation, endotheliopathy and poor outcome in trauma patients.
The association between sympathoadrenal activation, endotheliopathy, and poor outcome in trauma has only been demonstrated in smaller patient cohorts and animal models but needs confirmation in a large independent patient cohort.
Prospective observational study of 424 trauma patients admitted to a level 1 Trauma Center. Admission plasma levels of catecholamines (adrenaline, noradrenaline) and biomarkers reflecting endothelial damage (syndecan-1, thrombomodulin, and sE-selectin) were measured and demography, injury type and severity, physiology, treatment, and mortality up till 28 days were recorded.
Patients had a median ISS of 17 with 72% suffering from blunt injury. Adrenaline and noradrenaline correlated with syndecan-1 (r = 0.38, P < 0.001 and r = 0.23, P < 0.001, respectively) but adrenaline was the only independent predictor of syndecan-1 by multiple linear regression adjusted for age, injury severity score, Glascow Coma Scale, systolic blood pressure, base excess, platelet count, hemoglobin, prehospital plasma, and prehospital fluids (100 pg/mL higher adrenaline predicted 2.75 ng/mL higher syndecan-1, P < 0.001). By Cox analyses adjusted for age, sex, injury severity score, Glascow Coma Scale, base excess, platelet count and hemoglobin, adrenaline, and syndecan-1 were the only independent predictors of both <24-hours, 7-day and 28-day mortality (all P < 0.05). Furthermore, noradrenaline was an independent predictor of <24-hours mortality and thrombomodulin was an independent predictor of 7-day and 28-day mortality (all P < 0.05).
We confirmed that sympathoadrenal activation was strongly and independently associated with endothelial glycocalyx and cell damage (ie, endotheliopathy) and furthermore that sympathoadrenal activation and endotheliopathy were independent predictors of mortality in trauma patients.
研究并证实创伤患者交感肾上腺激活、内皮病变与不良预后之间的关联。
交感肾上腺激活、内皮病变与创伤不良预后之间的关联仅在较小的患者队列和动物模型中得到证实，但需要在大型独立患者队列中进行确认。
对一家一级创伤中心收治的424例创伤患者进行前瞻性观察研究。测量入院时血浆儿茶酚胺（肾上腺素、去甲肾上腺素）水平以及反映内皮损伤的生物标志物（syndecan-1、血栓调节蛋白和可溶性E选择素），并记录患者的人口统计学资料、损伤类型和严重程度、生理状况、治疗情况以及直至28天的死亡率。
患者的损伤严重度评分（ISS）中位数为17，72%为钝性损伤。肾上腺素和去甲肾上腺素与syndecan-1相关（分别为r = 0.38，P < 0.001和r = 0.23，P < 0.001），但在对年龄、损伤严重度评分、格拉斯哥昏迷量表、收缩压、碱剩余、血小板计数、血红蛋白、院前血浆和院前液体进行多元线性回归调整后，肾上腺素是syndecan-1的唯一独立预测因子（肾上腺素每升高100 pg/mL，syndecan-1升高2.75 ng/mL，P < 0.001）。通过对年龄、性别、损伤严重度评分、格拉斯哥昏迷量表、碱剩余、血小板计数和血红蛋白、肾上腺素和syndecan-1进行Cox分析调整后，肾上腺素和syndecan-1是24小时内、7天和28天死亡率的唯一独立预测因子（均P < 0.05）。此外，去甲肾上腺素是24小时内死亡率的独立预测因子，血栓调节蛋白是7天和28天死亡率的独立预测因子（均P < 0.05）。
我们证实交感肾上腺激活与内皮糖萼和细胞损伤（即内皮病变）密切且独立相关，此外，交感肾上腺激活和内皮病变是创伤患者死亡率的独立预测因子。
Zotero 插件