Inflammatory markers: Superior predictors of adverse outcome in blunt trauma patients?

C. M. Dunham, David Frankenfield, H. Belzberg, C. E. Wiles, B. Cushing, Z. Grant

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objective: To assess whether variables reflective of early metabolic responses to injury are predictors of outcome in critically ill trauma patients. Design: Clinical inception cohort study comparing conventional measures of injury severity with early host response markers for the correlation of each with outcome. These data are prospectively collected in a group of patients being evaluated in a nutritional support investigation. Setting: Intensive care unit (ICU) of a major Level I trauma center. Patients: Seventeen blunt trauma patients, aged 18 to 60 yrs with an Injury Severity Score of ≥15, requiring early mechanical ventilation. Interventions: Blood and urine samples were routinely obtained from patients undergoing nutritional support by one of three routes. Measurements and Main Results: Conventional assessment was consistent with moderate severity and variation: Injury Severity Score, 41 ± 15; Glasgow Coma Score, 11 ± 4; admission circulating lactate concentration, 4.8 ± 2.2 mmol/L; and first 24- hr transfusion requirement, 3.1 ± 2.9 L. The mean concentrations of inflammatory marker during the first week were: cholesterol, 2.67 ± 0.80 mmol/L (103.2 ± 31 mg/dL); C-reactive protein, 23 ± 11 mg/dL; transferrin, 1.44 ± 0.47 g/L; glucose, 9.21 ± 2.27 mmol/L (166 ± 41 mg/dL); albumin, 26 ± 5 g/L; and nitrogen loss, 24 ± 9 g/d. Hospital outcome variables were: ventilator days, 17 ± 7; ICU days, 26 ± 10; hospital days, 38 ± 15; occurrence rate of adult respiratory distress syndrome (ARDS), 35%; infections, 82%; multiple organ failure, 71%; and total of hospital plus professional charges, $125,000 ± $56,000. A significant (p < .05), but weak, correlation existed between all seven outcome variables and the inflammatory markers: ventilator days with cholesterol and C-reactive protein; ICU days with transferrin; total stay with cholesterol; ARDS with C-reactive protein; infections with glucose, cholesterol, and nitrogen loss; multiple organ failure with albumin and C-reactive protein; and financial charges with glucose. However, a significant correlation existed between only two of seven outcome variables and conventional measures of severity: multiple organ failure with lactate and financial charges with transfusion requirement. Conclusion: Readily obtainable inflammatory marker measurements may better reflect the summation effects of the early perfusion deficit and tissue injury in the blunt trauma patient compared with conventional measures of injury severity.

Original languageEnglish (US)
Pages (from-to)667-672
Number of pages6
JournalCritical Care Medicine
Volume22
Issue number4
DOIs
StatePublished - Jan 1 1994

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C-Reactive Protein
Multiple Organ Failure
Wounds and Injuries
Cholesterol
Intensive Care Units
Injury Severity Score
Nutritional Support
Adult Respiratory Distress Syndrome
Mechanical Ventilators
Transferrin
Glucose
Albumins
Lactic Acid
Nitrogen
Nonpenetrating Wounds
Trauma Centers
Coma
Infection
Artificial Respiration
Critical Illness

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Dunham, C. M. ; Frankenfield, David ; Belzberg, H. ; Wiles, C. E. ; Cushing, B. ; Grant, Z. / Inflammatory markers : Superior predictors of adverse outcome in blunt trauma patients?. In: Critical Care Medicine. 1994 ; Vol. 22, No. 4. pp. 667-672.
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title = "Inflammatory markers: Superior predictors of adverse outcome in blunt trauma patients?",
abstract = "Objective: To assess whether variables reflective of early metabolic responses to injury are predictors of outcome in critically ill trauma patients. Design: Clinical inception cohort study comparing conventional measures of injury severity with early host response markers for the correlation of each with outcome. These data are prospectively collected in a group of patients being evaluated in a nutritional support investigation. Setting: Intensive care unit (ICU) of a major Level I trauma center. Patients: Seventeen blunt trauma patients, aged 18 to 60 yrs with an Injury Severity Score of ≥15, requiring early mechanical ventilation. Interventions: Blood and urine samples were routinely obtained from patients undergoing nutritional support by one of three routes. Measurements and Main Results: Conventional assessment was consistent with moderate severity and variation: Injury Severity Score, 41 ± 15; Glasgow Coma Score, 11 ± 4; admission circulating lactate concentration, 4.8 ± 2.2 mmol/L; and first 24- hr transfusion requirement, 3.1 ± 2.9 L. The mean concentrations of inflammatory marker during the first week were: cholesterol, 2.67 ± 0.80 mmol/L (103.2 ± 31 mg/dL); C-reactive protein, 23 ± 11 mg/dL; transferrin, 1.44 ± 0.47 g/L; glucose, 9.21 ± 2.27 mmol/L (166 ± 41 mg/dL); albumin, 26 ± 5 g/L; and nitrogen loss, 24 ± 9 g/d. Hospital outcome variables were: ventilator days, 17 ± 7; ICU days, 26 ± 10; hospital days, 38 ± 15; occurrence rate of adult respiratory distress syndrome (ARDS), 35{\%}; infections, 82{\%}; multiple organ failure, 71{\%}; and total of hospital plus professional charges, $125,000 ± $56,000. A significant (p < .05), but weak, correlation existed between all seven outcome variables and the inflammatory markers: ventilator days with cholesterol and C-reactive protein; ICU days with transferrin; total stay with cholesterol; ARDS with C-reactive protein; infections with glucose, cholesterol, and nitrogen loss; multiple organ failure with albumin and C-reactive protein; and financial charges with glucose. However, a significant correlation existed between only two of seven outcome variables and conventional measures of severity: multiple organ failure with lactate and financial charges with transfusion requirement. Conclusion: Readily obtainable inflammatory marker measurements may better reflect the summation effects of the early perfusion deficit and tissue injury in the blunt trauma patient compared with conventional measures of injury severity.",
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Inflammatory markers : Superior predictors of adverse outcome in blunt trauma patients? / Dunham, C. M.; Frankenfield, David; Belzberg, H.; Wiles, C. E.; Cushing, B.; Grant, Z.

In: Critical Care Medicine, Vol. 22, No. 4, 01.01.1994, p. 667-672.

Research output: Contribution to journalArticle

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T1 - Inflammatory markers

T2 - Superior predictors of adverse outcome in blunt trauma patients?

AU - Dunham, C. M.

AU - Frankenfield, David

AU - Belzberg, H.

AU - Wiles, C. E.

AU - Cushing, B.

AU - Grant, Z.

PY - 1994/1/1

Y1 - 1994/1/1

N2 - Objective: To assess whether variables reflective of early metabolic responses to injury are predictors of outcome in critically ill trauma patients. Design: Clinical inception cohort study comparing conventional measures of injury severity with early host response markers for the correlation of each with outcome. These data are prospectively collected in a group of patients being evaluated in a nutritional support investigation. Setting: Intensive care unit (ICU) of a major Level I trauma center. Patients: Seventeen blunt trauma patients, aged 18 to 60 yrs with an Injury Severity Score of ≥15, requiring early mechanical ventilation. Interventions: Blood and urine samples were routinely obtained from patients undergoing nutritional support by one of three routes. Measurements and Main Results: Conventional assessment was consistent with moderate severity and variation: Injury Severity Score, 41 ± 15; Glasgow Coma Score, 11 ± 4; admission circulating lactate concentration, 4.8 ± 2.2 mmol/L; and first 24- hr transfusion requirement, 3.1 ± 2.9 L. The mean concentrations of inflammatory marker during the first week were: cholesterol, 2.67 ± 0.80 mmol/L (103.2 ± 31 mg/dL); C-reactive protein, 23 ± 11 mg/dL; transferrin, 1.44 ± 0.47 g/L; glucose, 9.21 ± 2.27 mmol/L (166 ± 41 mg/dL); albumin, 26 ± 5 g/L; and nitrogen loss, 24 ± 9 g/d. Hospital outcome variables were: ventilator days, 17 ± 7; ICU days, 26 ± 10; hospital days, 38 ± 15; occurrence rate of adult respiratory distress syndrome (ARDS), 35%; infections, 82%; multiple organ failure, 71%; and total of hospital plus professional charges, $125,000 ± $56,000. A significant (p < .05), but weak, correlation existed between all seven outcome variables and the inflammatory markers: ventilator days with cholesterol and C-reactive protein; ICU days with transferrin; total stay with cholesterol; ARDS with C-reactive protein; infections with glucose, cholesterol, and nitrogen loss; multiple organ failure with albumin and C-reactive protein; and financial charges with glucose. However, a significant correlation existed between only two of seven outcome variables and conventional measures of severity: multiple organ failure with lactate and financial charges with transfusion requirement. Conclusion: Readily obtainable inflammatory marker measurements may better reflect the summation effects of the early perfusion deficit and tissue injury in the blunt trauma patient compared with conventional measures of injury severity.

AB - Objective: To assess whether variables reflective of early metabolic responses to injury are predictors of outcome in critically ill trauma patients. Design: Clinical inception cohort study comparing conventional measures of injury severity with early host response markers for the correlation of each with outcome. These data are prospectively collected in a group of patients being evaluated in a nutritional support investigation. Setting: Intensive care unit (ICU) of a major Level I trauma center. Patients: Seventeen blunt trauma patients, aged 18 to 60 yrs with an Injury Severity Score of ≥15, requiring early mechanical ventilation. Interventions: Blood and urine samples were routinely obtained from patients undergoing nutritional support by one of three routes. Measurements and Main Results: Conventional assessment was consistent with moderate severity and variation: Injury Severity Score, 41 ± 15; Glasgow Coma Score, 11 ± 4; admission circulating lactate concentration, 4.8 ± 2.2 mmol/L; and first 24- hr transfusion requirement, 3.1 ± 2.9 L. The mean concentrations of inflammatory marker during the first week were: cholesterol, 2.67 ± 0.80 mmol/L (103.2 ± 31 mg/dL); C-reactive protein, 23 ± 11 mg/dL; transferrin, 1.44 ± 0.47 g/L; glucose, 9.21 ± 2.27 mmol/L (166 ± 41 mg/dL); albumin, 26 ± 5 g/L; and nitrogen loss, 24 ± 9 g/d. Hospital outcome variables were: ventilator days, 17 ± 7; ICU days, 26 ± 10; hospital days, 38 ± 15; occurrence rate of adult respiratory distress syndrome (ARDS), 35%; infections, 82%; multiple organ failure, 71%; and total of hospital plus professional charges, $125,000 ± $56,000. A significant (p < .05), but weak, correlation existed between all seven outcome variables and the inflammatory markers: ventilator days with cholesterol and C-reactive protein; ICU days with transferrin; total stay with cholesterol; ARDS with C-reactive protein; infections with glucose, cholesterol, and nitrogen loss; multiple organ failure with albumin and C-reactive protein; and financial charges with glucose. However, a significant correlation existed between only two of seven outcome variables and conventional measures of severity: multiple organ failure with lactate and financial charges with transfusion requirement. Conclusion: Readily obtainable inflammatory marker measurements may better reflect the summation effects of the early perfusion deficit and tissue injury in the blunt trauma patient compared with conventional measures of injury severity.

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