Eritropoetin kao biološki marker procene ishoda lečenja politraumatizovanih pacijenata

Abstract

Trauma je jedan od najznačajnijih problema razvijenog sveta. Ona je treći uzrok smrti posle kardiovaskularnih i malignih bolesti, a prvi u najvitalnijoj životnoj populaciji. Trauma je akutno oštećenje organizma sa razaranjem tkiva i odgovarajućim funkcionalnim poremećajem, prouzrokovano delovanjem neke spoljašnje sile (mehanička, termička, hemijska, aktinička). Procenjivanje stepena obolelosti organizma predstavlja jedan od osnovnih postupaka u medicinskoj praksi. Eritropoetin je endogeni hormon za koji u poslednje vreme vlada veliko interesovanje za primenu u proceni i terapiji pacijenata. C-reaktivni protein (CRP) je protein koji se stvara u jetri, a čija je povećana koncentracija u serumu direktno povezana sa postojećom inflamacijom u organizmu. IL-6 je citokin koji se stvara kao odgovor na stimulans u širokom spektru imunološki aktivnih ćelija. Važan je u stvaranju reaktanata akutne faze od strane hepatocita i izgleda da je glavni vodič impulsa koji upravljaju njihovom sekrecijom. Cilj: Analiza epidemioloških podataka politraumatizovanih bolesnika (pol i uzrast), uzroka povređivanja, kao i procena težine provreda na osnovu kliničkih (anatomskih i fizioloških) skorova. Praćenje vrednosti koncentracije eritropoetina i njene korelacije sa vrednostima hemoglobina, IL-6 i kliničkih skorova. Analiza korelacije koncentracija eritropoetina sa ishodom lečenja politraumatizovanih pacijenata Metode: U ovo istraživanje uključena su 43 bolesnika lečenih zbog politraume. Za svakog pacijenta su prikupljani sledeći podaci: uzrast, pol, tip povrede, etiologija povređivanja. Pacijenti su skorovani po: ISS skoru, AIS skoru, APACHE II i SOFA skoru. Takođe je praćena količina primljene transfuzije krvi i krvnih derivata, broj dana hospitalizacije i ishod lečenja. Po prijemu, a zatim 24h, 48h, 72h i sedmog dana pacijentima je uzimana krv za biohemijske analize...

Introduction: Traumatic injuries are one of the most important problems in developed world. They are the third cause of death after cardiovascular and neoplastic diseases. They are the first leading cause of death in the most productive population. Trauma is defined as an acute organ and system of organs damage accompanied by functional disarrangements caused by some external forces (mechanical or chemical). Evaluation of the degree of the injuries is one of the most important initial steps in clinical care of these patients. Erythropoietin is an endogenous hormone that recently has been evaluated as a prognostic and therapeutic maker in different patients’ populations. C-reactive protein (CRP) is a protein synthetized in the liver and its concentration in blood correlates with inflammation. IL-6 is a cytokine, produced in many different immunologically active cells as a result of inflammation. It is an essential element in formation of acute phase reactant by hepatocytes and seems to be the main regulator in their synthesis and secretion. Goal: To evaluate epidemiological data of patients with polytrauma (age and sex), cause leading to the injury as well as prediction of severity of injury by clinical (anatomic and physiologic) scores. Furthermore we trended erythropoietin levels and investigated if they correlate with hemoglobin levels, IL-6 levels as well as clinical scores. Methods: This study included 43 patients who were hospitalized following trauma leading to multiple organ injuries. Date consisting of age, sex, type and the cause of injury were collected from the patients’ charts. Patients were further scored by ISS, AIS, SOFA and APACHE score. Additionally we evaluated number of red blood cells units that were transfused, length of stay (LOS) and outcome. Results: This study included 43 patients with polytrauma of whom 32 (74.52%) were male and 11 (25.58%) were female. Most common cause of polytrauma was due to motor vehicle accidents (MVA) - 27 (62.8%) followed by falls 13 (30.2%) and the other causes were described in 3 patents (7%)...