Impact of Injury Severity on the Inflammatory State and Severe Anemia
Impact of Injury Severity on the Inflammatory State and Severe Anemia
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DOI：
10.1016/j.jss.2019.10.046
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发表时间：
2020-04-01
影响因子：
2.2
通讯作者：
Mohr, Alicia M.
中科院分区：
文献类型：
--
作者：
Apple, Camille G.;Miller, Elizabeth S.;Mohr, Alicia M.
背景：严重创伤是发病率和死亡率的主要原因。我们的目标是通过损伤严重度评分（ISS）分析钝性创伤性损伤，并与选择性髋关节修复术（作为暂时性损伤）和健康对照进行比较，假设更严重的损伤将导致神经内分泌激活增加、全身炎症和更严重的贫血。材料和方法：在1级创伤中心进行了一项前瞻性观察性队列研究，比较了钝性创伤患者（n = 37）、择期髋关节置换患者（n = 26），健康对照组（n = 8）。评估骨髓和血浆的肾上腺素能亢进状态、红细胞生成和全身炎症。创伤患者的ISS范围为4至41，并分为四分位数进行分析。ISS四分位数分别为4-13、14-20、21-26和27- 41。结果：血浆去甲肾上腺素、白细胞介素6、肿瘤坏死因子α和铁调素均随ISS增加而进行性升高。血红蛋白随ISS增加而显著降低，浓缩红细胞（pRBC）输注随ISS增加而增加。择期髋关节置换术患者有适当的增加，在骨髓中表达的促红细胞生成素和促红细胞生成素受体，这是不存在的所有trauma patient groups.Conclusions：增加神经内分泌激活，全身炎症，贫血与恶化的损伤严重程度，较低的年龄，并增加pRBC输血。选择性髋关节置换患者只有轻微的全身炎症，骨髓对贫血有适当的反应。这项研究表明损伤严重程度、神经内分泌激活、全身炎症和骨髓对贫血的反应之间存在联系。(C)2019爱思唯尔公司All rights reserved.
Background: Severe traumatic injury is a major cause of morbidity and mortality. Our goal was to analyze blunt traumatic injury by injury severity score (ISS) and compare with elective hip repair, as a transient injury, and healthy control with the hypothesis that more severe injury would lead to an increase in neuroendocrine activation, systemic inflammation, and worse anemia.Materials and methods: A prospective observational cohort study was performed at a level 1 trauma center, comparing blunt trauma patients (n = 37), elective hip replacement patients (n = 26), and healthy controls (n = 8). Bone marrow and plasma were assessed for hyper-adrenergic state, erythropoiesis, and systemic inflammation. Trauma patient's ISS ranged from 4 to 41 and were broken down into quartiles for analysis. The ISS quartiles were 4-13, 14-20, 21-26, and 27-41.Results: Plasma norepinephrine, interleukin-6, tumor necrosis factor-alpha, and hepcidin increased progressively as ISS increased. Hemoglobin significantly decreased as ISS increased and packed red blood cell (pRBC) transfusion increased as ISS increased. Elective hip replacement patients had an appropriate increase in the bone marrow expression of erythropoietin and the erythropoietin receptor, which was absent in all trauma patient groups.Conclusions: Increased neuroendocrine activation, systemic inflammation, and anemia correlated with worsening injury severity, lower age, and increased pRBC transfusions. Elective hip replacement patients have only minimal systemic inflammation with an appropriate bone marrow response to anemia. This study demonstrates a link between injury severity, neuroendocrine activation, systemic inflammation, and the bone marrow response to anemia. (C) 2019 Elsevier Inc. All rights reserved.