Urinary Biomarkers are Associated with Severity and Mechanism of Injury.
Urinary Biomarkers are Associated with Severity and Mechanism of Injury.
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DOI：
10.1097/shk.0000000000000784
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发表时间：
2017-05
期刊：
影响因子：
--
通讯作者：
Chung KK
中科院分区：
文献类型：
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作者：
Janak JC;Stewart IJ;Sosnov JA;Howard JT;Siew ED;Chan MM;Wickersham N;Ikizler TA;Chung KK
战斗相关的爆炸创伤导致大规模的组织损伤，往往涉及多个系统。此外，基于潜在生物学机制的损伤严重程度的急性测量对于这些类型的患者的分类和治疗可能是重要的。我们假设尿生物标志物（UB）可以反映损伤的严重程度，并且在战斗伤员队列中，与枪伤（GSW）相比，爆炸伤的尿生物标志物（UB）会升高。我们还假设，在平民队列中，烧伤患者的UB高于非烧伤创伤患者。在80名遭受战斗相关伤害的军人中，我们使用广义估计方程来比较（1）损伤严重程度和（2）损伤机制的UB对数转换浓度的差异。在22名平民患者中，我们进行了Kruskal-Wallis检验，以比较烧伤和非烧伤创伤分层的UB差异。在军事队列中，除IL-18外，严重战斗相关损伤（损伤严重度评分≥25）患者的所有UB均显著（p<0.05）较高。此外，原始细胞与GSW患者相比，所有粗UB浓度均显著更高（p<0.05）。在调整损伤严重程度评分和UB抽血时间后，爆炸性损伤患者的KIM-1（2.80 vs. 2.31; p=0.03）和LFABP（-1.11 vs.-1.92; p=0.02）显著较高。烧伤与非烧伤平民创伤患者之间的UB无显著差异。未来的研究需要了解创伤的生理反应，以及UB反映这些潜在过程的程度。
Combat-related blast trauma results in massive tissue injury and tends to involve multiple systems. Further, an acute measure of injury severity based on underlying biological mechanisms may be important for the triage and treatment of these types of patients. We hypothesized that urinary biomarkers (UBs) would reflect severity of injury and that they would be elevated for blast injuries compared to gunshot wounds (GSW) in a cohort of combat casualties. We also postulated that UBs would be higher in patients with burns compared to patients with non-burn trauma in a civilian cohort. Among 80 service members who sustained combat-related injuries, we performed generalized estimating equations to compare differences in log-transformed concentrations of the UBs by both (1) injury severity and (2) injury mechanism. Among 22 civilian patients, we performed Kruskal-Wallis tests to compare differences for the UBs stratified by burn and non-burn trauma. In the military cohort, with the exception of IL-18, all UBs were significantly (p<0.05) higher for patients with a severe combat-related injury (Injury Severity Score≥25). In addition, all crude UBs concentrations were significantly higher for blast vs. GSW patients (p<0.05). After adjusting for injury severity score and time of UB draw, KIM-1 (2.80 vs. 2.31; p=0.03) and LFABP (−1.11 vs. −1.92; p=0.02) were significantly higher for patients with a blast mechanism of injury. There were no significant differences in UBs between burn and non-burn civilian trauma patients. Future studies are needed to understand the physiologic response to trauma and the extent that UBs reflect these underlying processes.