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首页> 外文期刊>Journal of Clinical Medicine >Post-Traumatic Sepsis Is Associated with Increased C5a and Decreased TAFI Levels
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Post-Traumatic Sepsis Is Associated with Increased C5a and Decreased TAFI Levels

机译：创伤后败血症与C5A增加相关，降低TAFI水平

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Background: Sepsis frequently occurs after major trauma and is closely associated with dysregulations in the inflammatory/complement and coagulation system. Thrombin-activatable fibrinolysis inhibitor (TAFI) plays a dual role as an anti-fibrinolytic and anti-inflammatory factor by downregulating complement anaphylatoxin C5a. The purpose of this study was to investigate the association between TAFI and C5a levels and the development of post-traumatic sepsis. Furthermore, the predictive potential of both TAFI and C5a to indicate sepsis occurrence in polytraumatized patients was assessed. Methods: Upon admission to the emergency department (ED) and daily for the subsequent ten days, circulating levels of TAFI and C5a were determined in 48 severely injured trauma patients (injury severity score (ISS) ≥ 16). Frequency matching according to the ISS in septic vs. non-septic patients was performed. Trauma and physiologic characteristics, as well as outcomes, were assessed. Statistical correlation analyses and cut-off values for predicting sepsis were calculated. Results: Fourteen patients developed sepsis, while 34 patients did not show any signs of sepsis (no sepsis). Overall injury severity, as well as demographic parameters, were comparable between both groups (ISS: 25.78 ± 2.36 no sepsis vs. 23.46 ± 2.79 sepsis). Septic patients had significantly increased C5a levels (21.62 ± 3.14 vs. 13.40 ± 1.29 ng/mL; p 0.05) and reduced TAFI levels upon admission to the ED (40,951 ± 5637 vs. 61,865 ± 4370 ng/mL; p 0.05) compared to the no sepsis group. Negative correlations between TAFI and C5a ( p = 0.0104) and TAFI and lactate ( p = 0.0423) and positive correlations between C5a and lactate ( p = 0.0173), as well as C5a and the respiratory rate ( p = 0.0266), were found. In addition, correlation analyses of both TAFI and C5a with the sequential (sepsis-related) organ failure assessment (SOFA) score have confirmed their potential as early sepsis biomarkers. Cut-off values for predicting sepsis were 54,857 ng/mL for TAFI with an area under the curve (AUC) of 0.7550 ( p = 0.032) and 17 ng/mL for C5a with an AUC of 0.7286 ( p = 0.034). Conclusion: The development of sepsis is associated with early decreased TAFI and increased C5a levels after major trauma. Both elevated C5a and decreased TAFI may serve as promising predictive factors for the development of sepsis after polytrauma.
机译：背景：脓毒症经常发生在重大创伤后发生，并且与炎症/补充和凝血系统中的疑难解失用密切相关。凝血酶激活纤维蛋白溶解抑制剂（TAFI）通过下调补蛋白C5A来利用作为抗纤维蛋白溶解和抗炎因子的双重作用。本研究的目的是探讨TAFI和C5A水平与创伤后败血症的发展。此外，评估了TAFI和C5A的预测潜力，表明在多重患者中患有败血症患者的发生。方法：在急诊部门（ED）和每日入院时，随后的十天，TAFI和C5A的循环水平均在48名严重受伤的创伤患者（伤害严重程度（ISS）≥16）中确定。频率匹配根据脓毒症与非化脓性患者的ISS。评估创伤和生理特性以及结果。计算统计相关分析和用于预测败血症的截止值。结果：十四名患者开发了败血症，而34名患者没有显示出脓毒症的任何迹象（没有败血症）。两组（ISS：25.78±2.36之间的总体损伤严重程度以及人口统计参数在败血症与23.46±2.79败血症之间相当。脓毒症患者的C5A水平显着增加（21.62±3.14与13.40±1.29 ng / ml; P <0.05），并在入院时减少了TAFI水平（40,951±5637与61,865±4370 ng / ml; P <0.05）与NO SEPSIS组相比。发现TAFI和C5A（P = 0.0104）和TAFI之间的负相关性和乳酸（P = 0.0423）和C5A和乳酸之间的正相关（P = 0.0173），以及C5A和呼吸速率（P = 0.0266）。此外，TAFI和C5A的相关分析与顺序（败血症相关）器官失效评估（沙发）评分证实了它们作为早期败血症生物标志物的潜力。用于预测败血症的截止值为TAFI为54,85​​7ng / ml，具有0.7550（P = 0.032）的曲线（AUC）下的区域，C5A为0.7286的C5a（P = 0.034）。结论：败血症的发展与早期减少的TAFI和主要创伤后的C5A水平增加有关。升高的C5A和降低的TAFI可能是在多毛症后开发败血症的预测因素。

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