Protein C Depletion Early After Trauma Increases the Risk of Ventilator-Associated Pneumonia

Abstract

Critically ill trauma patients have an early activation of the PC pathway, associated with a rapid decrease in the plasma levels of this protein and increase in EPCR. Plasma levels of PC return to normal levels within 24 hours in most patients. However, patients who go on to acquire VAP have persistently low plasma levels of PC in the immediate period after trauma. Whether PC could play a mechanistic role in the host response against nosocomial lung infection warrants further study.

Elderly trauma patients have high circulating noradrenaline levels but attenuated release of adrenaline, platelets, and leukocytes in response to increasing injury severity

“…Given the previously demonstrated association between enhanced protein C consumption and poor outcome in trauma patients (39), exhaustion of the natural anticoagulant systems may also in part explain the high mortality in elderly trauma patients. However, since both TFPI and protein S are increased in elderly (21), this finding may also reflect a normal, age-related change in coagulation factor levels.…”

The burden of infection in severely injured trauma patients and the relationship with admission shock severity

“…There is a high degree of cross talk between coagulation and inflammation, and early coagulopathy has been associated with the subsequent development of infections. 11,33,34 Tissue injuryYrelated and trauma-related hemorrhage stimulate an inflammatory response initially characterized by increased levels of proinflammatory cytokines and activation of neutrophils. However, severe trauma is also associated with immunosuppression, predominantly seen as anergy in the adaptive immune system T-lymphocyte populations.…”

Comparative Response of Platelet fV and Plasma fV to Activated Protein C and Relevance to a Model of Acute Traumatic Coagulopathy

“…Severe trauma featuring both tissue damage and shock is associated with abnormal results in ex vivo coagulation function tests, independent of iatrogenic perturbations caused by hemodilution with crystalloid or colloid [3], [4]. This early coagulopathy has been linked with increased transfusion requirements, mortality, and morbidity [5], [6]. Termed acute traumatic coagulopathy (ATC), this syndrome is defined by an international normalized ratio (INR) greater than 1.2 and occurs within the first thirty minutes following trauma [3], [4], [7], [8].…”