Clinical Significance of C-Reactive Protein in Patients with Trauma on Arrival

Abstract

Objective: To investigate to investigate significance of C-reactive protein (CRP) in patients with trauma on arrival. Materials: From September 2017 to February 2018, a medical chart review was retrospectively performed for all patients with trauma who were admitted to our department. Methods: The subjects were divided into two groups: a CRP-negative group (initial CRP level ≤0.3 mg/dl) and a CRP-positive group (> 0.3 mg/dl). For the CRP-positive group, we additionally investigated the cause of the increased level of CRP. Results: There were 33 cases in the CRP-positive group and 168 in the CRP-negative group. The age and ratio of lymphocytes in the CRP-positive group was significantly higher than those in the CRP-negative group. Twenty-two to twenty-eight of the 33 cases (67-85%) had an infection, 3 of 33 (9%) had a delayed visit (over 24 h from the onset of the trauma) to the emergency department, and 2 cases (6%) had malignancy in the CRP-positive group. All subjects with an increased CRP level on arrival potentially had underlying diseases that might have caused their trauma. Conclusion: Some traumatized patients may have elevated CRP levels on arrival due to underlying diseases capable of causing trauma. An increased initial level of CRP did not significantly affect the clinical outcome; however, physicians should pay attention to the cause of the increased CRP level, which may affect the patientʼs outcome. Exploring increased CRP levels may be useful for identifying the mechanism underlying the occurrence of trauma.

A Case of Acute Respiratory Distress Syndrome Following Non-thoracic Trauma in a Patient With Idiopathic Pulmonary Fibrosis

“…While respiratory status can deteriorate rapidly due to trauma-induced cytokines and lung damage from damage-associated molecular patterns, it is exceedingly rare for respiratory function to deteriorate so rapidly even with more severe trauma [ 11 ]. Thirdly, considering the possibility of acute interstitial pneumonia preceding the trauma, with the respiratory condition deteriorating rapidly during transport, it is not uncommon for endogenous diseases to precede trauma, especially in the elderly [ 12 ]. In the present case, there is a possibility of acute exacerbation of interstitial pneumonia complicating the underlying lung fibrosis.…”

A High Level of Fibrinogen Degradation Product on Arrival as the Only Clue Suggesting Deterioration in a Blunt Trauma Patient

“…The major cause of unstable circulation after trauma in the acute phase is usually hemorrhage followed by neurogenic issues induced by spinal cord injury and/or obstruction induced by tension pneumothorax or cardiac tamponade [ 1 , 2 ]. However, in rare cases, preceding endogenous diseases can cause shock in trauma patients [ 3 ]. We report the case of a blunt trauma patient in whom a high fibrinogen degradation product (FDP) level on arrival was the only clue indicating the deterioration of her condition.…”