Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
J Surg Res. 2023 Nov;291:691-699. doi: 10.1016/j.jss.2023.07.020. Epub 2023 Aug 8.
Seven key inflammatory biomarkers were recently found to be associated with the risk of mortality in a multicenter study of massively transfused patients. The aim of this prospective single-center study was to determine which of these early inflammatory markers could predict 30-d mortality among all critically injured trauma patients.
Serum samples were collected at 6, 24, and 72 h from 238 consecutive patients admitted to the intensive care unit following traumatic injury. Inflammatory markers syndecan-1, eotaxin, IL-1ra, IL-6, IL-8, IL-10, IP-10, and MCP-1 were analyzed via multiplex enzyme-linked immunosorbent assay. Subgroup analysis was performed for patients undergoing massive transfusion (≥5 red blood cells), submassive transfusion (1-4 red blood cells), or no transfusion during the first 4 h postinjury. The primary outcome of 30-d survival was modeled as a function of each biomarker and confounders using repeat measures logistic regression.
Patients had a median age of 51.3 y [33.7, 70.2], 70.6% were male, 17.4% experienced penetrating trauma, and had a median injury severity score of 22 [14, 33]. IL-1ra, IL-8, IL-10, and MCP-1 were significantly increased during the first 72 h in nonsurvivors (n = 31). Elevated IL-1ra, IL-8, IL-10, and MCP-1 at 6 h postinjury were associated with 30-d mortality. By contrast, serum syndecan-1 and eotaxin levels were not associated with mortality at any time point. IL-8 and lactate were increased at 6 h in 30-d nonsurvivors for patients receiving submassive transfusion (n = 78).
Early evaluations of IL-1ra, IL-8, IL-10, and IP-10 within 6 h of injury are useful predictors of 30-d mortality. Subgroup analysis suggests that transfusion status does not significantly affect early inflammatory markers.
Level III, prognostic/epidemiological.
最近的一项多中心研究发现，7 种关键炎症生物标志物与大量输血患者的死亡风险相关。本前瞻性单中心研究的目的是确定这些早期炎症标志物中哪些可以预测所有严重创伤患者的 30 天死亡率。
从创伤后入住重症监护病房的 238 例连续患者中，分别在第 6、24 和 72 小时采集血清样本。通过多重酶联免疫吸附试验分析炎症标志物 syndecan-1、eotaxin、IL-1ra、IL-6、IL-8、IL-10、IP-10 和 MCP-1。对接受大量输血（≥5 单位红细胞）、亚大量输血（1-4 单位红细胞）或受伤后前 4 小时内未输血的患者进行亚组分析。30 天生存的主要结局被建模为每个生物标志物和重复测量逻辑回归的协变量的函数。
患者的中位年龄为 51.3[33.7, 70.2]岁，70.6%为男性，17.4%为穿透性创伤，损伤严重程度评分为 22[14, 33]。在第 72 小时内，非幸存者（n=31）中 IL-1ra、IL-8、IL-10 和 MCP-1 显著增加。受伤后 6 小时升高的 IL-1ra、IL-8、IL-10 和 MCP-1 与 30 天死亡率相关。相比之下，血清 syndecan-1 和 eotaxin 水平在任何时间点均与死亡率无关。在接受亚大量输血的 30 天非幸存者中，IL-8 和乳酸在 6 小时时升高（n=78）。
受伤后 6 小时内早期评估 IL-1ra、IL-8、IL-10 和 IP-10 是 30 天死亡率的有用预测指标。亚组分析表明，输血状态并不显著影响早期炎症标志物。
III 级，预后/流行病学。
