Fri., 10/17/08 Basic Science, Paper #16, 9:30 am OTA-2008
Procalcitonin (PCT) in Multiple Trauma Patients: Prognostic Relevance of PCT Plasma Levels and Effects of PCT Polymorphisms (CALCA) on Clinical Outcome and Posttraumatic PCT Synthesis
Frank Hildebrand, MD1 (n); Manfred Stuhrmann, MD2 (n); Matthias Kalmbach, MD2 (n);
Andrea Kaapke, MD3 (n); Michael Frink, MD1 (n); Christian Krettek, MD1 (a-AO Foundation);
1Trauma Department, Hannover Medical School, Hannover, Germany
2Institute of Human Genetics, Hannover Medical School, Hannover, Germany
Purpose: Severe trauma induces sustained inflammatory changes that are related to secondary organ dysfunction. Recently, we showed that (1) posttraumatic systemic inflammatory response syndrome (SIRS) was associated with a single nucleotide polymorphism (SNP) in the cytokine interleukin [IL]-6 gene, and (2) adult respiratory distress syndrome (ARDS) was associated with an IL-8 SNP and IL-8 plasma concentrations in German trauma patients. Another clinically relevant marker in polytraumatized patients is the serum procalcitonin (PCT) level. Therefore, we conducted a prospective cohort study to investigate whether polymorphisms in the calcitonin (CALCA) gene are associated with PCT levels and posttraumatic complications like SIRS, multiple organ dysfunction syndrome (MODS), or sepsis.
Methods: The inclusion criteria of this prospective study were: (1) Injury Severity Score (ISS) >16; (2) age 18-60 years; and (3) survival >48 hours after injury. During a 14-day observation period, blood samples were drawn once daily for systemic PCT concentrations. The clinical course was recorded once daily. For analysis of allele frequencies, genotype distribution and PCT concentrations of polytraumatized patients were separated, according to the development of MODS, SIRS, and sepsis. For statistical analysis, we used Spearman rank correlation coefficient, logistic regression and analysis, Fisher exact test, and Student t test; statistical significance was P <0.05.
Results: 137 multiple trauma patients fulfilled the inclusion criteria. PCT plasma levels were significantly higher in patients with sepsis and MODS. Furthermore, PCT revealed a high specificity (99.1%) and overall accuracy (88.1%) in predicting sepsis at admission. No differences were observed for allelic and genotypic distributions between patients and 104 healthy German controls. When trauma patients were grouped according to different clinical outcome parameters (sepsis, MODS, SIRS) no association between any of the studied parameters and CALCA SNPs was observed. Additionally, no association was observed between CALCA SNPs and PCT levels.
Conclusion: We conclude that PCT seems to represent a reliable marker for early prediction of infectious complications after trauma. However, CALCA polymorphisms are unlikely to influence PCT levels and clinical outcome in polytraumatized patients.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.