Changes of procalcitonin level in multiple trauma patients

Abstract

Background: Some aspects of the pathophysiology of complications in multiple-trauma patients still remain unclear. Mediators of inflammation have been postulated as playing a key role in being responsible for life threatening complications of multiple trauma patients. The objective of this study was to evaluate the prognostic value of procalcitonin (PCT) level in multiple trauma patients. Methods: A prospective study took place including patients with multiple trauma hospitalised in several hospital units. PCT level was measured in blood from 45 patients, aged 18-70 years using enzyme-linked immunoassay. The patients were divided into three groups: group I -individuals with multiple trauma with central nervous system injury; group II -those with multiple trauma without CNS injury; and group III -patients with isolated central nervous system injury. Results: Initial PCT levels were below 0.5 ng mL -1 regardless of the cause of trauma. In the 24 th hour of observation, a statistically significant increase of PCT concentration vs. initial levels was recorded in all groups of patients. Then PCT levels decreased significantly at the 3 rd measurement point in all groups, and they remained unchanged until the last measurement. The highest levels of PCT were observed in multiple trauma patients without CNS injury (group II). In this group of patients, a significantly longer duration of surgery in the post-trauma period affected PCT levels. PCT concentrations in patients who died were significantly greater than in survivors. Conclusions: A long lasting elevated concentration of procalcitonin in the post-traumatic period, or its repeated increase, is a good marker of developing complications observed earlier than clinical manifestations.

A Broad-Spectrum Infection Diagnostic that Detects Pathogen-Associated Molecular Patterns (PAMPs) in Whole Blood

“…CRP and PCT values have been shown to be elevated in infections, with increasing levels correlating with likelihood of infection and sepsis severity ( Tsalik et al, 2012 , Loonen et al, 2014 , Carr, 2015 ). However, it is difficult to use these assays to distinguish between patients with sepsis versus sterile SIRS in subpopulations of patients who have experienced surgery ( Battistelli et al, 2014 , Stoppekamp et al, 2015 , Uzzan et al, 2006 , Kaukonen et al, 2015 ), burn injury ( Seoane et al, 2014 ), trauma( Wojtaszek et al, 2014 ) or stroke ( Li and Liu, 2015 ). In contrast, the unique clinical utility of the FcMBL-enabled PAMP assay presented here is that in addition to being able to rapidly and specifically detect the presence of infection in whole blood samples, the PAMP assay can reliably distinguish patients with infection from those with trauma-associated inflammation, thereby giving physicians clinically valuable, actionable information.…”

“…However, while rising levels of the CRP and PCT correlate with an increased likelihood of infection and sepsis severity, these tests produce a wide range of sensitivities and specificities ( Pierrakos and Vincent, 2010 , Carr, 2015 ). Moreover, none of these inflammatory biomarkers unequivocally distinguishes infection-induced SIRS from sterile SIRS caused by burn injury ( Seoane et al, 2014 ), trauma ( Wojtaszek et al, 2014 ) or surgery ( Battistelli et al, 2014 ). Other groups (e.g.…”

Can APACHE II, SOFA, ISS, and RTS Severity Scores be Used to Predict Septic Complications in Multiple Trauma Patients?

“…activation of the immune cell function, induction of stress hormones synthesis, synthesis of arachidonic acid derivatives, activation of the coagulation cascade and the complement system, all play important physiological roles. These proinflammatory responses may lead to multiple organ dysfunctions with possibly lethal consequences [6][7][8]. The severity of the initial injury characterizing each system and organ can be quantified.…”

Letter to the Editor: Early serum procalcitonin, but not C reactive protein, might improve the prediction of sepsis in multiple trauma patients. A prospective observational study

“…Severe traumatic lesions are triggers for the early activation of systemic inflammation, aimed to maintain homeostasis, but which may lead to development of the possibly lethal multiple organ dysfunction syndrome [3,4]. The initial pro-inflammatory syndrome is soon followed by an anti-inflammatory response that may lead to immune suppression and carries a high risk for the development of severe infections and sepsis, the main cause of late mortality in trauma [5].…”