INCREASED PLASMA KYNURENINE VALUES AND KYNURENINE-TRYPTOPHAN RATIOS AFTER MAJOR TRAUMA ARE EARLY INDICATORS FOR THE DEVELOPMENT OF SEPSIS
INCREASED PLASMA KYNURENINE VALUES AND KYNURENINE-TRYPTOPHAN RATIOS AFTER MAJOR TRAUMA ARE EARLY INDICATORS FOR THE DEVELOPMENT OF SEPSIS
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DOI：
10.1097/shk.0b013e31819714fa
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发表时间：
2009-07-01
期刊：
影响因子：
3.1
通讯作者：
Wild, Michael
中科院分区：
文献类型：
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作者：
Loegters, Tim T.;Laryea, Maurice D.;Wild, Michael
犬尿氨酸，色氨酸的主要降解产物，已被证明直接损害组织，但其可能的贡献创伤后发病率是未知的。在这里，我们研究了犬尿氨酸在严重创伤后患者中的动力学，以及这是否与创伤后脓毒症的发展相关。犬尿氨酸和色氨酸水平的60例多发性损伤患者的损伤严重程度评分超过16前瞻性定量的高效液相色谱法。从入院到入院后第10天，每天采集血样。无论损伤模式如何，在入院后第1天，在后来发生脓毒症的患者的血液中已经检测到显著增加的犬尿氨酸值（P < 0.01）。相比之下，非脓毒症患者的犬尿氨酸值在整个观察期间保持较低。然而，与健康对照组相比，所有患者均表现出显著降低的色氨酸值（P < 0.01）。此外，犬尿氨酸-色氨酸比值显著增加可快速预测随后的脓毒症、多器官衰竭和死亡（P < 0.01）。犬尿氨酸值和犬尿氨酸-色氨酸比值的增加均预测创伤后脓毒症和器官衰竭的发展。这需要在后续研究中得到验证。
Kynurenine, the major degradation product of tryptophan has been shown to directly damage tissues, but its possible contribution to posttraumatic morbidity is unknown. Here, we studied the kinetics of kynurenine in patients after major trauma and whether this correlates with the development of posttraumatic sepsis. Kynurenine and tryptophan levels of 60 multiple-injured patients with Injury Severity Score of more than 16 were quantified prospectively by high-performance liquid chromatography. Blood samples were obtained daily from admission until day 10 after admission. Significantly increased kynurenine values were detectable already at day 1 after admission in blood from patients who later developed sepsis, regardless of injury pattern (P < 0.01). In contrast, kynurenine values of nonsepsis patients remained low throughout the observation period. However, all patients exhibited significantly decreased tryptophan values versus healthy controls (P < 0.01). Moreover, significantly increased kynurenine-tryptophan ratios rapidly predicted subsequent sepsis, multiple organ failure, and death (P < 0.01). Both increased kynurenine values and kynurenine-tryptophan ratios predicted posttraumatic development of sepsis and organ failure. This ought to be validated in subsequent studies.