Are Pentraxin 3 and Transsignaling Early Markers for Immunologic Injury Severity in Polytrauma? A Pilot Study

• Published in: Clinical orthopaedics and related research 2013-09, Vol.471 (9), p.2822-2830
• Main Authors: Kleber, Christian, Becker, Christopher A., Schmidt-Bleek, Katharina, Schaser, Klaus D., Haas, Norbert P.
• Format: Article
• Language: English
• Subjects: Adult; Biomarkers - blood; C-Reactive Protein - metabolism; Conservative Orthopedics; Humans; Inflammation - blood; Inflammation - etiology; Injury Severity Score; Interleukin-6 - blood; Medicine; Medicine & Public Health; Multiple Trauma - blood; Multiple Trauma - complications; Orthopedics; Pilot Projects; Predictive Value of Tests; Prospective Studies; Receptors, Interleukin-6 - blood; Serum Amyloid P-Component - metabolism; Sports Medicine; Surgery; Surgical Orthopedics; Symposium: Tscherne Festschrift; Systemic Inflammatory Response Syndrome - blood; Systemic Inflammatory Response Syndrome - etiology; Trauma
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-013-2922-x

Background Inflammatory-related conditions and organ failure (OF) lead to late trauma mortality. Cytokine profiles can predict adverse events and mortality, potentially guiding treatment strategies (damage control surgery versus early total care). However, the specific cytokines to predict the clinical course in polytraumatized patients are not fully identified. Questions/purposes We investigated the early pentraxin 3 (PTX3), IL-6, soluble IL-6 receptor (sIL-6R), and transsignaling ratio (TSR) in polytraumatized patients to estimate immunologic injury severity and predict OF and survival. Methods We prospectively followed 58 patients with severe polytrauma, six patients with minor trauma, and 10 healthy volunteers. The mean Injury Severity Score (ISS) was 43 points and the mean Hannover Polytrauma Score (PTS) was 59 points, with a consequently high mortality rate (30%). Twenty-seven of the 58 polytraumatized patients (46%) developed OF, 67% systemic inflammatory response syndrome, and 38% sepsis. Results Mean sIL-6R concentrations in polytrauma initially were low. Mean PTX3 concentrations were high and peaked at 24 hours. The mean TSR peaked at 6 hours; at that time, the mean value was higher for nonsurvivors. PTX3 concentrations at admission were associated with injury severity calculated by ISS and PTS. Higher PTX3 serum concentrations 24 hours after admission correlated with lower probability for survival. Conclusions PTX3, sIL-6R, and TSR were early markers for posttraumatic inflammatory status, OF, injury severity, and TSR for survival after polytrauma. The temporal profile of PTX3 and TSR might be used to anticipate the total injury severity and the clinical course and thereby guide decision making in polytraumatized patients. Level of Evidence Level II, prognostic study. See Instructions for Authors for a complete description of levels of evidence.