There has been limited research on assessing metalloproteinases (MMPs) 1, 2, and 7, as well as th... more There has been limited research on assessing metalloproteinases (MMPs) 1, 2, and 7, as well as their tissue inhibitors (TIMPs) 1, 2, 3, and 4 in the context of polytrauma. These proteins play crucial roles in various physiological and pathological processes and could be a reliable tool in polytrauma care. We aimed to determine their clinical relevance. We assessed 24 blunt polytrauma survivors and 12 fatalities (mean age, 44.2 years, mean ISS, 45) who were directly admitted to our Level I trauma center and spent at least one night in the intensive care unit. We measured serum levels of the selected proteins on admission (day 0) and days 1, 3, 5, 7, and 10. The serum levels of the seven proteins varied considerably among individuals, resulting in similar median trend curves for TIMP1 and TIMP4 and for MMP1, MMP2, TIMP2, and TIMP3. We also found a significant interrelationship between the MMP2, TIMP2, and TIMP3 levels at the same measurement points. Furthermore, we calculated significant cross-correlations between MMP7 and MMP1, TIMP1 and MMP7, TIMP3 and MMP1, TIMP3 and MMP2, and TIMP4 and TIMP3 and an almost significant correlation between MMP7 and TIMP1 for a two-day-lag. The autocorrelation coefficient reached statistical significance for MMP1 and TIMP3. Finally, lower TIMP1 serum levels were associated with in-hospital mortality upon admission. The causal effects and interrelationships between selected proteins might provide new insights into the interactions of MMPs and TIMPs. Identifying the underlying causes might help develop personalized therapies for patients with multiple injuries. Administering recombinant TIMP1 or increasing endogenous production could improve outcomes for those with multiple injuries. However, before justifying further investigations into basic research and clinical relevance, our findings must be validated in a multicenter study using independent cohorts to account for clinical and biological variability.
European journal of medical research, Apr 10, 2024
Background Managing polytrauma victims poses a significant challenge to clinicians since applying... more Background Managing polytrauma victims poses a significant challenge to clinicians since applying the same therapy to patients with similar injury patterns may result in different outcomes. Using serum biomarkers hopefully allows for treating each multiple injured in the best possible individual way. Since matrix metalloproteinases (MMPs) play pivotal roles in various physiological processes, they might be a reliable tool in polytrauma care. Methods We evaluated 24 blunt polytrauma survivors and 12 fatalities (mean age, 44.2 years, mean ISS, 45) who were directly admitted to our Level I trauma center and stayed at the intensive care unit for at least one night. We determined their MMP3, MMP8, MMP9, MMP10, MMP12, and MMP13 serum levels at admission (day 0) and on days 1, 3, 5, 7, and 10. Results Median MMP8, MMP9, and MMP12 levels immediately rose after the polytrauma occurred; however, they significantly decreased from admission to day 1 and significantly increased from day 1 to day 10, showing similar time trajectories and (very) strong correlations between each two of the three enzyme levels assessed at the same measurement point. For a two-day lag, autocorrelations were significant for MMP8 (− 0.512) and MMP9 (− 0.302) and for cross-correlations between MMP8 and MMP9 (− 0.439), MMP8 and MMP12 (− 0.416), and MMP9 and MMP12 (− 0.307). Moreover, median MMP3, MMP10, and MMP13 levels significantly increased from admission to day 3 and significantly decreased from day 3 to day 10, showing similar time trajectories and an (almost) strong association between every 2 levels until day 7. Significant cross-correlations were detected between MMP3 and MMP10 (0.414) and MMP13 and MMP10 (0.362). Finally, the MMP10 day 0 level was identified as a predictor for in-hospital mortality. Any increase of the MMP10 level by 200 pg/mL decreased the odds of dying by 28.5%. Conclusions The time trajectories of the highly varying individual MMP levels elucidate the involvement of these enzymes in the endogenous defense response following polytrauma. Similar time courses of MMP levels might indicate similar injury causes, whereas lead-lag effects reveal causative relations between several enzyme pairs. Finally, MMP10 abundantly released into circulation after polytrauma might have a protective effect against dying.
Bildgebung des stumpfen Thoraxtraumas Jedes Jahr erleiden in Deutschland mehr als 20.000 Personen... more Bildgebung des stumpfen Thoraxtraumas Jedes Jahr erleiden in Deutschland mehr als 20.000 Personen eine Verletzung des Brustkorbs [1]. Ein Thoraxtrauma kann sowohl isoliert (25-35% [2]) als auch in Kombination mit anderen Verletzungen auftreten. Von den polytraumatisierten Patienten, die im Jahresbericht 2012 des Traumaregisters der Deutschen Gesellschaft für Unfallchirurgie (DGU) inkludiert sind, erlitten 54,2% ein mittleres bis schweres Thoraxtrauma [3]. In der Regel spricht man von einem schweren Thoraxtrauma, wenn dem Patienten durch mechanische Gewalteinwirkung von außen oder innen eine schwere Verletzung des Brustkorbs, seiner Organe oder seiner angrenzenden Strukturen zugefügt wurde [4]. Dieses führt häufig zu ausgeprägter respiratorischer Insuffizienz (31%) oder Kreislaufversagen (26% [5]). Die Mortalität nach Thoraxtrauma liegt zwischen 10 und 30% [5, 6]. Patienten mit Thoraxtrauma verzeichnen eine höhere Inzidenz an Multiorganversagen als Verunfallte ohne Thoraxtrauma [7], wobei man davon ausgehen kann, dass ungefähr jeder vierte unfallbedingte Todesfall auf eine Verletzung des Brustkorbs zurückzuführen ist [8].
Trauma represents one of the leading causes of death worldwide. Traumatic injuries elicit a dynam... more Trauma represents one of the leading causes of death worldwide. Traumatic injuries elicit a dynamic in ammatory response with systemic release of in ammatory cytokines. Disbalance of this response can lead to systemic in ammatory response syndrome or compensatory anti-in ammatory response syndrome. As neutrophils play a major role in innate immune defense and are crucial in the injury-induced immunological response, we aimed to investigate systemic neutrophil-derived immunomodulators in trauma patients. Therefore, serum levels of neutrophil elastase (NE), myeloperoxidase (MPO), and citrullinated histone H3 (CitH3) were quanti ed in patients with injury severity scores above 15. Additionally, leukocyte, platelet, brinogen, and CRP levels were assessed. Lastly, we analyzed the association of neutrophil-derived factors with clinical severity scoring systems. Although the release of MPO, NE, and CitH3 was not predictive of mortality, we found a remarkable increase in MPO and NE in trauma patients as compared with healthy controls. We also found signi cantly increased levels of MPO and NE on days 1 and 5 after initial trauma in critically injured patients. Taken together, our data suggest a role for neutrophil activation and NETosis in trauma. Targeting exacerbated neutrophil activation might represent a new therapeutic option for critically injured patients.
The original version of this article, published on 17 March 2021, unfortunately contained a mista... more The original version of this article, published on 17 March 2021, unfortunately contained a mistake. The following correction has therefore been made in the original: The presentation of Fig. 3 was incorrect. The corrected figure is given below.
To proof the hypothesis that the results achieved by microfracture of the knee in clinical practi... more To proof the hypothesis that the results achieved by microfracture of the knee in clinical practice are not statistically comparable to those presented in controlled studies. Methods: Our literature search focused on patients with full-thickness cartilage defects of the knee who were treated with microfracture without implantation of a scaffold or injection of substitutes and whose functional capacity was assessed by clinical scores. Whereas these patients formed group A, group B consisted of 26 patients who had been treated at our Level I trauma center. The decision if microfracture was appropriate was made during an arthroscopy of the knee that was scheduled for the repair of meniscal and/or ligamental deficiencies. Due to missing preselection no exclusion criteria were defined. We compared the two groups by performing a correlation analysis. Results: Four randomized controlled trials and one prospective cohort study were detected which provided 187 patients for group A. Surprisingly, a very high correlation (Pearson coefficient r = 0.924, p = 0.008) was calculated between the score values, indicating similar postoperative outcome in both groups. Conclusions: Controlled studies may reflect general population results and therefore provide estimates of treatment effects which are applicable in usual clinical practice.
Our analyses of continuous outcome data were performed according to Borenstein [8] and Schwarzer ... more Our analyses of continuous outcome data were performed according to Borenstein [8] and Schwarzer [9-11] and calculated with the package "meta" in the statistic program R [12] using the random effects model of Schwarzer et al. [11] for weighting the individual studies. The treatment effect, i.e. the difference between the mean pre-and postoperative Lysholm Score values, was appointed as effect size [13]. Score values referring to other outcome measures than the
Since endothelial cells rapidly release Angiopoietin-2 (Ang-2) in response to vascular injury and... more Since endothelial cells rapidly release Angiopoietin-2 (Ang-2) in response to vascular injury and inflammatory stimuli, we aimed to investigate if its serum levels increase in polytraumatized patients. Our cohort study evaluated 28 blunt polytrauma survivors (mean age, 38.4 years; median ISS, 34) who were directly admitted to our level I trauma center in 2018. We assessed the serum Ang-2 level at admission and on days 1, 3, 5, 7, and 10 during hospitalization. Ang-2 was released into the circulation immediately after polytrauma. At admission (day 0), it amounted to 8286 ± 5068 pg/mL, three-and-a-half times the reference value of 2337 ± 650 pg/mL assessed in a healthy control group. Subgroup analysis provided a higher mean Ang-2 level in the CNSI group combining all patients suffering a brain or spinal cord injury compared to the non-CNSI group solely on day 0 [11083 ± 5408 pg/mL versus 3963 ± 2062 pg/mL; p < 0.001]. Whereas the mean Ang-2 level increased only in the non-CNSI grou...
Archives of Orthopaedic and Trauma Surgery, Apr 12, 2022
Purpose To analyze the changes of the clinical characteristics, injury patterns, and mortality ra... more Purpose To analyze the changes of the clinical characteristics, injury patterns, and mortality rates of polytraumatized patients within the past 25 years in a European Level I trauma center. Methods 953 consecutive polytraumatized patients treated at a single-level 1 trauma center between January 1995 and December 2019 were enrolled retrospectively. Polytrauma was defined as AIS ≥ 3 points in at least two different body regions. Retrospective data analysis on changes of clinical characteristics and mortality rates over time. Results A significant increase of the average age by 2 years per year of the study could be seen with a significant increase of geriatric patients over time. No changes of the median Injury Severity Score (ISS) could be seen over time, whereas the ISS significantly decreased by patient's year. The rates of concomitant severe traumatic brain injury (TBI) remained constant over time, and did not increase with rising age of the patients. Although, the mortality rate remained constant over time the relative risk of overall in-hospital mortality increased by 1.7% and the relative risk of late-phase mortality increased by 2.2% per patient's year. Conclusion The number of polytraumatized patients remained constant over the 25-year study period. Also, the mortality rates remained stable over time, although a significant increase of the average age of polytraumatized patients could be seen with stable injury severity scores. Severe TBI and age beyond 65 years remained independent prognostic factors on the latephase survival of polytraumatized patients. Trial registration: NCT04723992.
Acute respiratory distress syndrome (ARDS), which is associated with major morbidity and high mor... more Acute respiratory distress syndrome (ARDS), which is associated with major morbidity and high mortality, is commonly developed by polytraumatized patients. Its pathogenesis is complex, and its development is difficult to anticipate, as candidate biomarkers for the prediction of ARDS were found not to be reliable for clinical use. In this prospective study, we assessed the serum antigen levels of tissue plasminogen activator (tPA) and plasminogen activator inhibitor type-1 (PAI-1) of 28 survivors of blunt polytrauma (age ≥18 years; injury severity score ≥16) at admission and on days 1, 3, 5, 7, 10, 14, and 21 of hospitalization. Our results show that these patients presented high mean tPA and PAI-1 antigen levels at admission; despite their decline, these parameters remained elevated for 3 weeks. Over this period, the mean tPA antigen level was higher in polytrauma victims suffering from ARDS than in those without ARDS, whereas the mean PAI-1 level was higher in polytrauma victims sustaining pneumonia than in those without pneumonia. Moreover, in each individual developing ARDS, the polytraumarelated elevated tPA antigen level either continued to rise after admission or suffered a second increase up to the onset of ARDS, declining immediately thereafter. Therefore, our findings support the assessment of serum tPA antigen levels after the initial treatment of polytraumatized patients, as this parameter shows potential as a biomarker for the development of ARDS and for the consequent identification of high-risk individuals.
Introduction Numerous papers in different fields have already shown that CT imaging of the Muscul... more Introduction Numerous papers in different fields have already shown that CT imaging of the Musculus Psoas Major (MPM) can be used to predict patient outcome. Unfortunately, most of the methods presented in the literature are very complex and not easy to perform in the clinic. Therefore, the objectives of the study were to introduce a novel and convenient method for measuring the MPM to trauma surgeons and to prove the association between MPM morphology and mortality in elderly polytraumatized patients. Material and methods The retrospective outcome study was conducted at our level I trauma center. All patients admitted from 2006 to 2020 were included if they (1) presented with multiple injuries (≥2 body regions) and an Injury Severity Score (ISS) ≥16, (2) were at least 65 years of age, and (3) were diagnosed using a whole-body computed tomography. Subsequently, the ratios of short-axis to long-axis of both MPM were measured, and their mean value was evaluated as a candidate predictor of 31-day mortality. Results Our study group consisted of 158 patients (63.3% male; median age, 76 years; median ISS, 25). In the survivors (55.7%), the mean MPM score was significantly higher compared to the fatalities (0.57 versus 0.48; p < 0.0001). Multivariate binary logistic regression analysis identified the MPM score as a protective predictor of 31 day-mortality (OR = 0.92, p < 0.001), whereas age (OR 1.08, p = 0.002 and ISS (OR 1.06, p = 0.006) revealed as significant risk factors for mortality. ROC statistics provided an AUC = 0.724 (p < 0.0001) and a cutoff level of 0,48 (sensitivity, 80.7%; specificity, 54.3%). Conclusion The present study demonstrated that MPM score levels lower than 0.48 might be considered an additional tool to identify elderly patients at high risk of death following major trauma. In our opinion, the assessment of the MPM score is an easy, convenient, and intuitive method to gain additional information quickly after admission to the hospital that could be implemented without great effort into daily clinical practice.
There has been limited research on assessing metalloproteinases (MMPs) 1, 2, and 7, as well as th... more There has been limited research on assessing metalloproteinases (MMPs) 1, 2, and 7, as well as their tissue inhibitors (TIMPs) 1, 2, 3, and 4 in the context of polytrauma. These proteins play crucial roles in various physiological and pathological processes and could be a reliable tool in polytrauma care. We aimed to determine their clinical relevance. We assessed 24 blunt polytrauma survivors and 12 fatalities (mean age, 44.2 years, mean ISS, 45) who were directly admitted to our Level I trauma center and spent at least one night in the intensive care unit. We measured serum levels of the selected proteins on admission (day 0) and days 1, 3, 5, 7, and 10. The serum levels of the seven proteins varied considerably among individuals, resulting in similar median trend curves for TIMP1 and TIMP4 and for MMP1, MMP2, TIMP2, and TIMP3. We also found a significant interrelationship between the MMP2, TIMP2, and TIMP3 levels at the same measurement points. Furthermore, we calculated significant cross-correlations between MMP7 and MMP1, TIMP1 and MMP7, TIMP3 and MMP1, TIMP3 and MMP2, and TIMP4 and TIMP3 and an almost significant correlation between MMP7 and TIMP1 for a two-day-lag. The autocorrelation coefficient reached statistical significance for MMP1 and TIMP3. Finally, lower TIMP1 serum levels were associated with in-hospital mortality upon admission. The causal effects and interrelationships between selected proteins might provide new insights into the interactions of MMPs and TIMPs. Identifying the underlying causes might help develop personalized therapies for patients with multiple injuries. Administering recombinant TIMP1 or increasing endogenous production could improve outcomes for those with multiple injuries. However, before justifying further investigations into basic research and clinical relevance, our findings must be validated in a multicenter study using independent cohorts to account for clinical and biological variability.
European journal of medical research, Apr 10, 2024
Background Managing polytrauma victims poses a significant challenge to clinicians since applying... more Background Managing polytrauma victims poses a significant challenge to clinicians since applying the same therapy to patients with similar injury patterns may result in different outcomes. Using serum biomarkers hopefully allows for treating each multiple injured in the best possible individual way. Since matrix metalloproteinases (MMPs) play pivotal roles in various physiological processes, they might be a reliable tool in polytrauma care. Methods We evaluated 24 blunt polytrauma survivors and 12 fatalities (mean age, 44.2 years, mean ISS, 45) who were directly admitted to our Level I trauma center and stayed at the intensive care unit for at least one night. We determined their MMP3, MMP8, MMP9, MMP10, MMP12, and MMP13 serum levels at admission (day 0) and on days 1, 3, 5, 7, and 10. Results Median MMP8, MMP9, and MMP12 levels immediately rose after the polytrauma occurred; however, they significantly decreased from admission to day 1 and significantly increased from day 1 to day 10, showing similar time trajectories and (very) strong correlations between each two of the three enzyme levels assessed at the same measurement point. For a two-day lag, autocorrelations were significant for MMP8 (− 0.512) and MMP9 (− 0.302) and for cross-correlations between MMP8 and MMP9 (− 0.439), MMP8 and MMP12 (− 0.416), and MMP9 and MMP12 (− 0.307). Moreover, median MMP3, MMP10, and MMP13 levels significantly increased from admission to day 3 and significantly decreased from day 3 to day 10, showing similar time trajectories and an (almost) strong association between every 2 levels until day 7. Significant cross-correlations were detected between MMP3 and MMP10 (0.414) and MMP13 and MMP10 (0.362). Finally, the MMP10 day 0 level was identified as a predictor for in-hospital mortality. Any increase of the MMP10 level by 200 pg/mL decreased the odds of dying by 28.5%. Conclusions The time trajectories of the highly varying individual MMP levels elucidate the involvement of these enzymes in the endogenous defense response following polytrauma. Similar time courses of MMP levels might indicate similar injury causes, whereas lead-lag effects reveal causative relations between several enzyme pairs. Finally, MMP10 abundantly released into circulation after polytrauma might have a protective effect against dying.
Bildgebung des stumpfen Thoraxtraumas Jedes Jahr erleiden in Deutschland mehr als 20.000 Personen... more Bildgebung des stumpfen Thoraxtraumas Jedes Jahr erleiden in Deutschland mehr als 20.000 Personen eine Verletzung des Brustkorbs [1]. Ein Thoraxtrauma kann sowohl isoliert (25-35% [2]) als auch in Kombination mit anderen Verletzungen auftreten. Von den polytraumatisierten Patienten, die im Jahresbericht 2012 des Traumaregisters der Deutschen Gesellschaft für Unfallchirurgie (DGU) inkludiert sind, erlitten 54,2% ein mittleres bis schweres Thoraxtrauma [3]. In der Regel spricht man von einem schweren Thoraxtrauma, wenn dem Patienten durch mechanische Gewalteinwirkung von außen oder innen eine schwere Verletzung des Brustkorbs, seiner Organe oder seiner angrenzenden Strukturen zugefügt wurde [4]. Dieses führt häufig zu ausgeprägter respiratorischer Insuffizienz (31%) oder Kreislaufversagen (26% [5]). Die Mortalität nach Thoraxtrauma liegt zwischen 10 und 30% [5, 6]. Patienten mit Thoraxtrauma verzeichnen eine höhere Inzidenz an Multiorganversagen als Verunfallte ohne Thoraxtrauma [7], wobei man davon ausgehen kann, dass ungefähr jeder vierte unfallbedingte Todesfall auf eine Verletzung des Brustkorbs zurückzuführen ist [8].
Trauma represents one of the leading causes of death worldwide. Traumatic injuries elicit a dynam... more Trauma represents one of the leading causes of death worldwide. Traumatic injuries elicit a dynamic in ammatory response with systemic release of in ammatory cytokines. Disbalance of this response can lead to systemic in ammatory response syndrome or compensatory anti-in ammatory response syndrome. As neutrophils play a major role in innate immune defense and are crucial in the injury-induced immunological response, we aimed to investigate systemic neutrophil-derived immunomodulators in trauma patients. Therefore, serum levels of neutrophil elastase (NE), myeloperoxidase (MPO), and citrullinated histone H3 (CitH3) were quanti ed in patients with injury severity scores above 15. Additionally, leukocyte, platelet, brinogen, and CRP levels were assessed. Lastly, we analyzed the association of neutrophil-derived factors with clinical severity scoring systems. Although the release of MPO, NE, and CitH3 was not predictive of mortality, we found a remarkable increase in MPO and NE in trauma patients as compared with healthy controls. We also found signi cantly increased levels of MPO and NE on days 1 and 5 after initial trauma in critically injured patients. Taken together, our data suggest a role for neutrophil activation and NETosis in trauma. Targeting exacerbated neutrophil activation might represent a new therapeutic option for critically injured patients.
The original version of this article, published on 17 March 2021, unfortunately contained a mista... more The original version of this article, published on 17 March 2021, unfortunately contained a mistake. The following correction has therefore been made in the original: The presentation of Fig. 3 was incorrect. The corrected figure is given below.
To proof the hypothesis that the results achieved by microfracture of the knee in clinical practi... more To proof the hypothesis that the results achieved by microfracture of the knee in clinical practice are not statistically comparable to those presented in controlled studies. Methods: Our literature search focused on patients with full-thickness cartilage defects of the knee who were treated with microfracture without implantation of a scaffold or injection of substitutes and whose functional capacity was assessed by clinical scores. Whereas these patients formed group A, group B consisted of 26 patients who had been treated at our Level I trauma center. The decision if microfracture was appropriate was made during an arthroscopy of the knee that was scheduled for the repair of meniscal and/or ligamental deficiencies. Due to missing preselection no exclusion criteria were defined. We compared the two groups by performing a correlation analysis. Results: Four randomized controlled trials and one prospective cohort study were detected which provided 187 patients for group A. Surprisingly, a very high correlation (Pearson coefficient r = 0.924, p = 0.008) was calculated between the score values, indicating similar postoperative outcome in both groups. Conclusions: Controlled studies may reflect general population results and therefore provide estimates of treatment effects which are applicable in usual clinical practice.
Our analyses of continuous outcome data were performed according to Borenstein [8] and Schwarzer ... more Our analyses of continuous outcome data were performed according to Borenstein [8] and Schwarzer [9-11] and calculated with the package "meta" in the statistic program R [12] using the random effects model of Schwarzer et al. [11] for weighting the individual studies. The treatment effect, i.e. the difference between the mean pre-and postoperative Lysholm Score values, was appointed as effect size [13]. Score values referring to other outcome measures than the
Since endothelial cells rapidly release Angiopoietin-2 (Ang-2) in response to vascular injury and... more Since endothelial cells rapidly release Angiopoietin-2 (Ang-2) in response to vascular injury and inflammatory stimuli, we aimed to investigate if its serum levels increase in polytraumatized patients. Our cohort study evaluated 28 blunt polytrauma survivors (mean age, 38.4 years; median ISS, 34) who were directly admitted to our level I trauma center in 2018. We assessed the serum Ang-2 level at admission and on days 1, 3, 5, 7, and 10 during hospitalization. Ang-2 was released into the circulation immediately after polytrauma. At admission (day 0), it amounted to 8286 ± 5068 pg/mL, three-and-a-half times the reference value of 2337 ± 650 pg/mL assessed in a healthy control group. Subgroup analysis provided a higher mean Ang-2 level in the CNSI group combining all patients suffering a brain or spinal cord injury compared to the non-CNSI group solely on day 0 [11083 ± 5408 pg/mL versus 3963 ± 2062 pg/mL; p < 0.001]. Whereas the mean Ang-2 level increased only in the non-CNSI grou...
Archives of Orthopaedic and Trauma Surgery, Apr 12, 2022
Purpose To analyze the changes of the clinical characteristics, injury patterns, and mortality ra... more Purpose To analyze the changes of the clinical characteristics, injury patterns, and mortality rates of polytraumatized patients within the past 25 years in a European Level I trauma center. Methods 953 consecutive polytraumatized patients treated at a single-level 1 trauma center between January 1995 and December 2019 were enrolled retrospectively. Polytrauma was defined as AIS ≥ 3 points in at least two different body regions. Retrospective data analysis on changes of clinical characteristics and mortality rates over time. Results A significant increase of the average age by 2 years per year of the study could be seen with a significant increase of geriatric patients over time. No changes of the median Injury Severity Score (ISS) could be seen over time, whereas the ISS significantly decreased by patient's year. The rates of concomitant severe traumatic brain injury (TBI) remained constant over time, and did not increase with rising age of the patients. Although, the mortality rate remained constant over time the relative risk of overall in-hospital mortality increased by 1.7% and the relative risk of late-phase mortality increased by 2.2% per patient's year. Conclusion The number of polytraumatized patients remained constant over the 25-year study period. Also, the mortality rates remained stable over time, although a significant increase of the average age of polytraumatized patients could be seen with stable injury severity scores. Severe TBI and age beyond 65 years remained independent prognostic factors on the latephase survival of polytraumatized patients. Trial registration: NCT04723992.
Acute respiratory distress syndrome (ARDS), which is associated with major morbidity and high mor... more Acute respiratory distress syndrome (ARDS), which is associated with major morbidity and high mortality, is commonly developed by polytraumatized patients. Its pathogenesis is complex, and its development is difficult to anticipate, as candidate biomarkers for the prediction of ARDS were found not to be reliable for clinical use. In this prospective study, we assessed the serum antigen levels of tissue plasminogen activator (tPA) and plasminogen activator inhibitor type-1 (PAI-1) of 28 survivors of blunt polytrauma (age ≥18 years; injury severity score ≥16) at admission and on days 1, 3, 5, 7, 10, 14, and 21 of hospitalization. Our results show that these patients presented high mean tPA and PAI-1 antigen levels at admission; despite their decline, these parameters remained elevated for 3 weeks. Over this period, the mean tPA antigen level was higher in polytrauma victims suffering from ARDS than in those without ARDS, whereas the mean PAI-1 level was higher in polytrauma victims sustaining pneumonia than in those without pneumonia. Moreover, in each individual developing ARDS, the polytraumarelated elevated tPA antigen level either continued to rise after admission or suffered a second increase up to the onset of ARDS, declining immediately thereafter. Therefore, our findings support the assessment of serum tPA antigen levels after the initial treatment of polytraumatized patients, as this parameter shows potential as a biomarker for the development of ARDS and for the consequent identification of high-risk individuals.
Introduction Numerous papers in different fields have already shown that CT imaging of the Muscul... more Introduction Numerous papers in different fields have already shown that CT imaging of the Musculus Psoas Major (MPM) can be used to predict patient outcome. Unfortunately, most of the methods presented in the literature are very complex and not easy to perform in the clinic. Therefore, the objectives of the study were to introduce a novel and convenient method for measuring the MPM to trauma surgeons and to prove the association between MPM morphology and mortality in elderly polytraumatized patients. Material and methods The retrospective outcome study was conducted at our level I trauma center. All patients admitted from 2006 to 2020 were included if they (1) presented with multiple injuries (≥2 body regions) and an Injury Severity Score (ISS) ≥16, (2) were at least 65 years of age, and (3) were diagnosed using a whole-body computed tomography. Subsequently, the ratios of short-axis to long-axis of both MPM were measured, and their mean value was evaluated as a candidate predictor of 31-day mortality. Results Our study group consisted of 158 patients (63.3% male; median age, 76 years; median ISS, 25). In the survivors (55.7%), the mean MPM score was significantly higher compared to the fatalities (0.57 versus 0.48; p < 0.0001). Multivariate binary logistic regression analysis identified the MPM score as a protective predictor of 31 day-mortality (OR = 0.92, p < 0.001), whereas age (OR 1.08, p = 0.002 and ISS (OR 1.06, p = 0.006) revealed as significant risk factors for mortality. ROC statistics provided an AUC = 0.724 (p < 0.0001) and a cutoff level of 0,48 (sensitivity, 80.7%; specificity, 54.3%). Conclusion The present study demonstrated that MPM score levels lower than 0.48 might be considered an additional tool to identify elderly patients at high risk of death following major trauma. In our opinion, the assessment of the MPM score is an easy, convenient, and intuitive method to gain additional information quickly after admission to the hospital that could be implemented without great effort into daily clinical practice.
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Papers by Lukas Negrin