Nosocomial infections after severe trauma are associated with lower apolipoproteins B and AII.
Nosocomial infections after severe trauma are associated with lower apolipoproteins B and AII.
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DOI：
10.1097/ta.0b013e3182826be0
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发表时间：
2013-04
期刊：
影响因子：
--
通讯作者：
Hall PR
中科院分区：
文献类型：
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作者：
Femling JK;West SD;Hauswald EK;Gresham HD;Hall PR
严重创伤后的感染是最初损伤后数天至数周内发病和死亡的重要原因。载脂蛋白在宿主防御中起重要作用，急性炎症反应改变了循环浓度。本研究的目的是确定严重创伤后感染患者的载脂蛋白水平是否显著低于未感染的创伤患者。我们对严重创伤（损伤严重度评分≥ 16）后入住重症监护室的前瞻性成人患者队列进行了病例对照研究。我们比较了创伤后30天内感染的患者（病例）和无感染的患者（对照组）的血浆载脂蛋白水平。在40名经历严重创伤的患者中，我们确定了22例在受伤后30天内发生感染的病例。与对照组相比，病例的创伤后血浆载脂蛋白-B（p=0.02）和载脂蛋白-AII（p=0.02）水平显著降低。与先前的研究一致，病例还接受了更大体积的晶体输注（p<0.01）和输血（p<0.01）。通过白细胞介素-6水平测量，病例还具有更严重的炎症反应（p=0.02）。与未感染对照组相比，严重创伤后感染与循环载脂蛋白降低相关。严重创伤后血浆载脂蛋白B和AII的显著降低可能是导致免疫功能受损的潜在原因。载脂蛋白是识别创伤后感染风险患者和预防院内感染干预措施的潜在靶点。
Infection following severe trauma is a significant cause of morbidity and mortality days to weeks after the initial injury. Apolipoproteins play important roles in host defense and circulating concentrations are altered by the acute inflammatory response. The purpose of this study was to determine if patients who acquire infection following severe trauma have significantly lower apolipoprotein levels than trauma patients who do not become infected. We conducted a case-control study on a prospectively identified cohort of adult patients admitted to our intensive care unit after severe trauma (Injury Severity Score ≥ 16). We compared plasma apolipoprotein levels between patients who acquired an infection within 30 days after trauma (cases) and those that remained infection free (controls). Of 40 patients experiencing severe trauma, we identified 22 cases that developed an infection within 30 days after injury. Cases had significantly lower post-trauma plasma levels of apolipoprotein-B (p=0.02) and apolipoprotein-AII (p=0.02) compared to controls. Consistent with previous studies, cases also received greater volumes of crystalloid infusions (p<0.01) and blood transfusions (p<0.01). Cases also had a more profound inflammatory response as measured by Interleukin-6 levels (p=0.02). Infection after severe trauma is associated with decreased circulating apolipoproteins as compared to uninfected controls. Profoundly decreased plasma apolipoproteins B and AII could potentially contribute to the impaired immunity after severe trauma. Apolipoproteins are potential targets for identifying those patients at risk of infection after trauma and for interventions aimed at preventing nosocomial infections.