E.R. Becker1, A.D. Price1, R.R. Shondel1, R.R. Schuster1, M.P. Smith1, T.A. Pritts1, M.D. Goodman1 1University Of Cincinnati, Department Of Surgery, Cincinnati, OH, USA
Introduction: Trauma induces cellular injury, coagulopathy, and a dysregulated physiologic response that result from endotheliopathy and the inflammatory response. This study aimed to compare early serum markers of endotheliopathy versus inflammatory cytokines to predict 30-day mortality in critically ill trauma patients.
Methods: Serum samples were collected from 232 trauma patients upon admission to the ICU. Twelve endothelial markers were analyzed, including angiopoietin 1, E-selectin, P-selectin, syndecan-1, thrombomodulin, and vascular endothelial growth factors. Inflammatory cytokines analyzed included eotaxin, IL-1ra, IL-6, IL-8, IL-10, IP-10, and MCP-1. The primary outcome was 30-day mortality with subgroup analyses based on transfusion status at 4 hours, defined as massive (>4u pRBC+WB), sub massive (1-4units pRBC+WB), and no transfusion.
Results: Subjects were 67% White, 67% male, with a median age of 58 years [34, 75]. Injuries were 88% blunt with a median injury severity score of 21 [14, 30] and a 7.3% mortality rate. By transfusion status, 19 (8%) patients required massive transfusion with 16% mortality, 40 (17%) required submassive transfusion with 13% mortality, and 173 (75%) did not require transfusion with 5% mortality. No endothelial marker was associated with mortality, even for transfusion subgroups. In contrast, 5 of the 7 inflammatory cytokines were associated with 30-day mortality (p<0.05) (Table). Inflammatory markers remained associated with mortality in the no transfusion cohort for eotaxin (p=0.04), IL-6 (p=0.005), and IL-8 (p=0.02), and the submassive transfusion cohort for IL-6 (p=0.045), IL-8 (p=0.04), and IP-10 (p=0.02).
Conclusion: Post-injury inflammatory markers collected at the time of ICU admission offer potential 30-day mortality predictive value even in patients who do not undergo massive transfusion. In contrast, early markers of endotheliopathy may not predict mortality.