Predictive Value of Medium-Sized Peptides in Patients with the Severe Combined Chest Trauma

Stupnytskyi M. A.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Commonly known that patophysiological processes evolved during the first days after trauma are reason for progress and final result of polyorgan failure. One of such process is endogenous intoxication. It grows owing to accumulation in the organism medium- and low-sized peptides in connection with increase of their pro- duction in one side and reduction of detoxicate possibilities of organism – in other side. Medium sized peptides (MSP) are universal markers of endogenous intoxication. The aim of the study was to investigate the possibility of using medium-sized peptides (MSP) markers for out- come prediction of patients with severe combined chest trauma during early posttraumatic period. 73 male patients with the severe combined thoracic trauma aged from 20 to 68 years were examined. The patients with blunt com- bined chest trauma contenting inside chest volumes, lung and heart contusions and ribs fractures were included for investigation. The patients were divided into two groups: the 1-st – the patients which survived and the 2-d – the patients with lethal outcome of trauma disease. Blood sampling was made in three stages: the 1-st – the 1-2-d day (10,75 – 33,5 hours after trauma); the 2-d – the 3-4-th day (48-75,2 hours) and the 3-d – 5-6-th day (97-122 hours). MSP in blood plasma was estimate spectrophotometrycally in UV range in 254 nm (peptide fraction) and 280 nm (fraction with aromatic groups) and it was expressed in conventional units which are equal quantitatively to extinction. ROC-analysis was used for the pa- rameters’ diagnostic value evaluation. The groups of the patients were characterized by absence of reliable differ- ence for age and admition time. The groups were similar in severity of skin, face, abdominal, thoracic and skeleton components of polytrauma. But in all cases the patients with lethal outcome of trauma disease had higher injuring points of all human anatomy parts except of skin shrouds. Reliable the groups were different by heaviness of com- bined trauma, head trauma and RTS score. At the 1-2-d day after trauma for the peptide fraction the area under ROC-curve was 0,7919 ± 0,05264, р < 0,0001, and for aromatic fraction -0,77 ± 0,05779, р < 0,0001. At the 3-4-th day for the peptide fraction the area under ROC-curve was 0,7547 ± 0,06809, р = 0,00074, and in case of aromatic fraction it was a little higher – 0,852 ± 0,05366, р < 0,0001. The highest area was under ROC-curve at 5-6-th day for peptide fraction and it was 0,8798 ± 0,0489, р < 0,0001, and it was a little less for aromatic MSP fraction – 0,7766 ± 0,06473, р = 0,00037. In case of peptide MSP fraction increase more than 0,3352 U in blood plasma of patients with combined chest trauma on 1-2-d day after trauma probability of lethal outcome increases to 37,49 – 44,7 %. If there is increase of aromatic MSP fraction more than 0,203 U on 3-4-th day mortality increases to 39,57 – 46,59 %. In case of peptide MSP frac- tion increase more than 0,3054 U and of aromatic MSP fraction more than 0,2374U 5-6-th day after trauma prob- ability of lethal outcome increases to 43,94 – 51,08 %. It should be noticed that concentration of MSP fractions are not independent one from another. Reliable strong correlation between MSP fraction was found out by rank method of Spearman correlation, which was r = 0,7771 (0,7139 – 0,8278), p < 0,0001. Simultaneous increase of both MSP fractions higher than critical value does not increase probability of lethal outcome for patients in comparison to the case of increase the concentration MSP only one fraction. The simplicity of MSP determination and no need to use special physical infrastructure together with existence of high prognostic significance indices gives conditions for monitoring of MSP concentration in patients with com- bined chest trauma during early posttraumatic period.

medium-sized peptides, combined chest trauma, outcome prediction