Serum Procalcitonin Levels in Patients With Multiple Injuries Including Visceral Trauma

Abstract

Procalcitonin (PCT) is known to be a reliable biomarker of sepsis and infection. Elevation of serum or plasma PCT has also been observed after major surgery or trauma. The association of PCT with the severity or location of injury in multiple traumatized (polytrauma) patients has not been clearly established, to date. The aim of this study was therefore to evaluate the sensitivity of PCT as a biomarker for the diagnosis of abdominal trauma. In a prospective clinical study, PCT, interrleukin-6, and C-reactive protein were measured in blood (serum) samples obtained in the emergency room (D0) from 74 patients with multiple injuries and in serum samples obtained on the 2 days after trauma (D1, D2). PCT significantly increased during the first two posttraumatic days in patients with severe multiple injuries (n = 24, day 1: 3.37 ng/mL +/- 0.92 ng/mL; day 2: 3.27 ng/mL +/-0.97 ng/mL) as compared with patients with identical Injury Severity Score but without abdominal injury (day 1: 0.6 ng/mL +/- 0.18 ng/mL; 0.61 ng/mL +/- 0.21 ng/mL). Interrleukin-6 and C-reactive protein serum levels were not able to discriminate between patients with and without abdominal injury during the 2-day posttrauma observation period. In a specific evaluation of the abdominal injury pattern, a significant increase of serum PCT concentrations was observed on day 1 after trauma of the liver (4.04 ng/mL +/- 0.99 ng/mL) and the gut (4.63 ng/mL +/- 1.12 ng/mL) compared with other abdominal lesions (0.62 ng/mL +/- 0.2 ng/mL). Markedly elevated PCT concentrations were also evident after severe multiple injuries, including the liver/spleen in combination with thorax trauma (9.37 ng/mL +/- 2.71 ng/mL). Assessment of serum PCT seems to be significantly increased after abdominal trauma in severe multiple traumatized patients and may serve as a useful biomarker to support other diagnostic methods including ultrasound and CT scan. Although elevated levels of PCT during the first 2 days after trauma are more likely to be indicative of traumatic impact than of an ongoing status of sepsis, multiple events such as surgery, massive transfusion, and intensive care therapy might influence the PCT concentration.

Procalcitonin in patients with influenza A (H1N1) infection and acute respiratory failure

“…Similar results were obtained by other researchers (12) . Castelli et al (13) also found that PCT values correlated with the severity and outcome of trauma.…”

“…Although this biomarker is practically considered almost the specific one for severe bacterial infections, it is partially elevated in other acute conditions (e.g., trauma, cardiac, fungal infections). In these situations, initial PCT values are prognostic of severity and outcome (12,(17)(18)(19) . Therefore, it is not surprising that initial serum PCT levels in patients with severe influenza A (H1N1) infection were predictive of mortality, although they were much lower than in patients with sepsis and even than in those with trauma.…”

Comparative Study of the Immunological Marker IL-6 and the Non-Immunological Marker PCT in Surgery Patients with Infections and Multiple Trauma

“…Meisner et al report that the severity of trauma correlates with PCT concentration and that the latter can serve to differentiate postoperative complications [33]. Other reports also show that PCT may be an indicator of injury and systemic inflammation in polytraumatized patients during the posttraumatic period [27,34].…”

Evaluación de la Nueva Definición de Politrauma en una Cohorte de Pacientes de 10 Hospitales Argentinos

“…Esta situación ha sido descrita como "dos o más lesiones significativas," 1 Adicionalmente, se la menciona como trauma múltiple, 4 lesión mayor 5 o trauma severo. 6 Estos enfoques múltiples hacen que cuando se hace mención a alguno de ellos no se pueda asegurar cuál es el criterio utilizado. 7 En el año 2014 Pape et al publicaron 8 una definición de consenso revisando el término politrauma y basándose en el Registro de Trauma Alemán.…”