• Coagulopathy
• Trauma
• Watson trauma pathway explorer

• INOV00040 Innovation Funding; University Hospital Zurich; 8091 Zurich; Switzerland

• Gender
• Inflammation markers
• Polytrauma
• Sepsis

• Humans
• Female
• Male
• Sepsis/blood
• Sepsis/etiology
• Sepsis/diagnosis
• Multiple Trauma/complications
• Multiple Trauma/blood
• Adult
• Biomarkers/blood
• Middle Aged
• C-Reactive Protein/metabolism
• C-Reactive Protein/analysis
• Retrospective Studies
• Procalcitonin/blood
• Leukocyte Count
• Sex Factors
• Aged
• Sex Characteristics
• Time Factors

• infection prediction
• open fractures
• orthopedic trauma
• postoperative infection
• procalcitonin (pct)

• SOFA
• biomarkers
• cytokines
• interleukin-10
• interleukin-6
• trauma

• Humans
• Biomarkers
• Interleukin-10
• Interleukin-6
• Interleukins
• Prognosis
• Prospective Studies

• COVID-19
• Feature selection
• Random contraction strategy
• Rosenbrock method
• Swarm intelligence
• WOA
• Whale optimization algorithm

• ABC
• Arterial blood gas analysis
• Bee-foraging learning
• Feature selection
• Kernel extreme learning machine
• Parameter optimization
• Pulmonary hypertension
• SMA
• Slime mould algorithm

• Blood culture
• contamination
• platelet
• sepsis
• transfusion-associated bacterial infection

Severe bleeding remains a prominent cause of early in-hospital mortality in major trauma patients. Thus, prompt prediction of patients at risk of massive transfusion (MT) is crucial. We investigated the ability of the inflammatory marker interleukin (IL)-6 to forecast MT in severely injured trauma patients. IL-6 plasma levels were measured upon admission. Receiver operating characteristic curves (ROCs) were calculated, and sensitivity and specificity were determined. In this retrospective study, a total of 468 predominantly male (77.8%) patients, with a median injury severity score (ISS) of 25 (17–34), were included. The Youden index for the prediction of MT within 6 and 24 h was 351 pg/mL. Patients were dichotomized into two groups: (i) low-IL-6 < 350 pg/mL and (ii) high-IL-6 ≥ 350 pg/mL. IL-6 ≥ 350 pg/mL was associated with a lower prothrombin time index, a higher activated partial thromboplastin time, and a lower fibrinogen concentration compared with IL-6 < 350 pg/mL (p <0.0001 for all). Thromboelastometric parameters were significantly different between groups (p <0.03 in all). More patients in the high-IL-6 group received MT (p <0.0001). The ROCs revealed an area under the curve of 0.76 vs. 0.82 for the high-IL-6 group for receiving MT in the first 6 and 24 h. IL-6 ≥ 350 pg/mL predicted MT within 6 and 24 h with a sensitivity of 45% and 58%, respectively, and a specificity of 89%. IL-6 ≥ 350 pg/mL appears to be a reasonable early predictor for coagulopathy and MT within the first 6 and 24 h intervals. Large-scale prospective studies are warranted to confirm these findings.

• coagulopathy
• interleukin-6
• massive transfusion
• trauma

• Adenovirus
• C-reactive protein
• procalcitonin
• respiratory infections

• Acute pancreatitis
• Procalcitonin
• Surgical infections

• Anti-Bacterial Agents/therapeutic use
• Antimicrobial Stewardship
• Biomarkers/analysis
• Delphi Technique
• Diverticulitis/drug therapy
• Humans
• Italy
• Pancreatitis/drug therapy
• Peritonitis/drug therapy
• Postoperative Complications/drug therapy
• Procalcitonin/analysis
• Skin Diseases, Infectious/drug therapy
• Surgical Wound Infection/drug therapy

• cardiology
• immunosuppression
• operative
• procalcitonin
• renal insufficiency
• surgical procedures
• trauma

• acid-base balance
• biomarker
• coagulation
• emergency room management
• inflammation
• laboratory parameters
• organ injury

• COVID-19
• IL-6
• JAK
• SARS-CoV-2
• STING
• TNF-α
• cytokine storm
• cytokines
• hemophagocytic lymphohistiocytosis
• hyperinflammatory
• proinflammatory
• sepsis

• Betacoronavirus
• COVID-19
• Coronavirus Infections/immunology
• Coronavirus Infections/therapy
• Cytokine Release Syndrome/immunology
• Cytokine Release Syndrome/virology
• Humans
• Immunomodulation
• Interleukin-6/immunology
• Pandemics
• Pneumonia, Viral/immunology
• Pneumonia, Viral/therapy
• SARS-CoV-2
• Sepsis/immunology

• P50 GM115305 NIGMS NIH HHS
• R01 AI152183 NIAID NIH HHS
• R01 HG010863 NHGRI NIH HHS
• R21 AI139021 NIAID NIH HHS

Biomarkers to guide antibiotic treatment decisions have been proposed as an effective way to enhancing a more appropriate use of antibiotics. As a biomarker, procalcitonin (PCT) has been found to have good specificity to distinguish bacterial from non-bacterial inflammations. Decisions regarding antibiotic use in an individual patient are complex and should be based on the pre-test probability for bacterial infection, the severity of presentation and the results of PCT serum concentration. In the context of a high pre-test probability for bacterial infections and/or a high-risk patient with sepsis, monitoring of PCT over time helps to track the resolution of infection and decisions regarding early stop of antibiotic treatment. As outlined by the Evidence Based Laboratory Medicine (EBLM), not only the pre-test probability but also the positive likelihood ratio influence the performance of a test do be really diagnostic. This aspect should be taken into account in the interpretation of the results of clinical trials evaluating the performance of PCT in guiding antibiotic therapy.

• Evidence Based Laboratory Medicine (EBLM)
• Procalcitonin (PCT)
• antibiotic therapy

• Adolescent
• Adult
• Aged
• Clinical Decision-Making
• Databases, Factual
• Female
• Humans
• Injury Severity Score
• Logistic Models
• Male
• Middle Aged
• Multiple Trauma/physiopathology
• Prognosis
• Prospective Studies
• Young Adult

Early accurate assessment of the clinical status of severely injured patients is crucial for guiding the surgical treatment strategy. Several scales are available to differentiate between risk categories. They vary between expert recommendations and scores developed on the basis of patient data (level II). We compared four established scoring systems in regard to their predictive abilities for early (e.g., hemorrhage-induced mortality) versus late (Multiple Organ Failure (MOF), sepsis, late death) in-hospital complications.

A database from a level I trauma center was used. The inclusion criteria implied an injury severity score (ISS) of ≥16 points, primary admission, and a complete data set from admission to hospital-day 21. The following four scales were tested: the clinical grading scale (CGS; covers acidosis, shock, coagulation, and soft tissue injuries), the modified clinical grading scale (mCGS; covers CGS with modifications), the polytrauma grading score (PTGS; covers shock, coagulation, and ISS), and the early appropriate care protocol (EAC; covers acid–base changes). Admission values were selected from each scale and the following endpoints were compared: mortality, pneumonia, sepsis, death from hemorrhagic shock, and multiple organ failure.

Shapiro-Wilk test for normal distribution, Pearson Chi square, odds ratios (OR) for all endpoints, 95% confidence intervals. Fitted, generalized linear models were used for prediction analysis. Krippendorff was used for comparison of CGS and mCGS. Alpha set at 0.05.

In total, 3668 severely injured patients were included (mean age, 45.8±20 years; mean ISS, 28.2±15.1 points; incidence of pneumonia, 19.0%; incidence of sepsis, 14.9%; death from hem. shock, 4.1%; death from multiple organ failure (MOF), 1.9%; mortality rate, 26.8%). Our data show distinct differences in the prediction of complications, including mortality, for these scores (OR ranging from 0.5 to 9.1). The PTGS demonstrated the highest predictive value for any late complication (OR = 2.0), sepsis (OR = 2.6, p = 0.05), or pneumonia (OR = 2.0, p = 0.2). The EAC demonstrated good prediction for hemorrhage-induced early mortality (OR = 7.1, p<0.0001), but did not predict late complications (sepsis, OR = 0.8 and p = 0.52; pneumonia, OR = 1.1 and p = 0.7) CGS and mCGS are not comparable and should not be used interchangeably (Krippendorff α = 0.045).

Our data show that prediction of complications is more precise after using values that covers different physiological systems (coagulation, hemorrhage, acid–base changes, and soft tissue damage) when compared with using values of only one physiological system (e.g., acidosis). When acid–base changes alone were tested in terms of complications, they were predictive of complications within 72 hours but failed to predict late complications. These findings should be considered when performing early assessment of trauma patients or for the development of new scores.

• Databases as Topic
• Humans
• Middle Aged
• Multiple Trauma/complications
• Multiple Trauma/diagnosis
• Outcome Assessment, Health Care
• Publications
• Reproducibility of Results
• Risk Assessment
• Risk Factors

One of the leading causes of morbidity and early-age mortality across the globe is trauma. It disrupts immune system homeostasis and intensely affects the innate and adaptive immune responses, predisposing patients to posttrauma complications and poor outcomes. Most of the studies on posttrauma cellular immune response have been centered on the T helper-1-T helper-2 imbalances after trauma. This study was conducted to understand the role of circulating novel T helper cells in the acute posttraumatic period and clinical outcome of trauma patients.

Signature cytokines and transcription factors of circulating Th (T helper)-9, Th-17, Th-22, and regulatory T helper cells were studied using flowcytometry along with serum biomarkers in 49 patients with polytraumatic injuries admitted to a tertiary care hospital. The patients were followed up until their outcome. The results were correlated with their clinical outcomes.

In patients who died, higher nTreg, iTreg, Tr1 (early-phase), and higher IRF4+Th-9, IL17+ Th-17, and RORγT+ Th-17 (mid-phase) were seen. However, by the late phase, only RORγT+ Th-17 remained higher. Serum IL-6 and PCT were found to be consistently higher. In survivors, higher Th-3 (early phase), Th-22 (mid-phase), and IRF4+Th-9, IL17+ Th-17, nTreg, Th-3 (late phase) were observed to have played a protective role. Serum IL-2, IL-4, IL-17A and IL-22 were significantly higher in survivors.

Different T helper subsets were observed to be playing pathogenic and protective roles in different phases of trauma and could be used for early prognostication and make way for noninvasive management of critically injured trauma patients by immunomodulation.

Khurana S, Bhardwaj N, Kumar S, Sagar S, Pal R, Soni KD, et al. Crosstalk between T Helper Cell Subsets and Their Roles in Immunopathogenesis and Outcome of Polytrauma Patients. Indian J Crit Care Med 2020;24(11):1037–1044.

• Th-17
• Th-22
• Th-3
• Th-9
• Tr1
• Trauma
• iTregs
• nTregs

Serial lactate measurement is found to predict mortality in septic shock. Majority of patients with perforation peritonitis for emergency laparotomy are in sepsis and mortality rate is substantial. However, lactate dynamics has not been studied in this patient population.

After institutional ethics clearance and informed written consent, 113 patients with suspected or proven perforation peritonitis presenting for emergency laparotomy were recruited in this prospective observational trial. Baseline Mannheim peritonitis index (MPI), SOFA and APACHE II score were calculated. Lactate values were obtained at baseline, immediate and 24-h postoperative period. Primary outcome was 28-day mortality.

Mortality was 15.04% at 28 days. Age, SOFA, qSOFA, APACHE, preoperative lactate, MPI and site of perforation were significantly different between survivors and non-survivors. Arterial lactate values at preoperative (cut off 2.75 mmol/L), immediate postoperative (cut off 2.8 mmol/L) and 24 h-postoperative period (cut off 2.45 mmol/L) independently predicted mortality at day 28. Combination of MPI and 24-h lactate value was best predictor of mortality with AUC 0.99.

Preoperative, immediate postoperative and 24-h postoperative lactate value independently predict 28-day mortality in perforation peritonitis patients undergoing emergency laparotomy. Combination of MPI and 24-h lactate value is the most accurate predictor of mortality.

Clinical Trial Registry of India - CTRI/2018/01/011103

• Emergency laparotomy
• Lactate
• Perforation peritonitis

Major trauma is associated with high incidence of septic complications and multiple organ dysfunction (MOD), which markedly influence the outcome of injured patients. Early identification of patients at risk of developing posttraumatic complications is crucial to provide early treatment and improve outcomes. We sought to evaluate the prognostic value of serum procalcitonin (PCT) levels after trauma as related to severity of injury, sepsis, organ dysfunction, and mortality.

We searched PubMed, MEDLINE, EMBASE, the Cochrane Database, and references of included articles. Two investigators independently identified eligible studies and extracted data. We included original studies that assessed the prognostic value of serum PCT levels in predicting severity of injury, sepsis, organ dysfunction, and mortality among critically injured adult patients.

Among 2015 citations, 19 studies (17 prospective; 2 retrospective) met inclusion criteria. Methodological quality of included studies was moderate. All studies showed a strong correlation between initial PCT levels and Injury Severity Score (ISS). Twelve out of 16 studies demonstrated significant elevation of initial PCT levels in patients who later developed sepsis after trauma. PCT level appeared a strong predictor of MOD in seven out of nine studies. While two studies did not show association between PCT levels and mortality, four studies demonstrated significant elevation of PCT levels in non-survivors versus survivors. One study reported that the PCT level of ≥ 5 ng/mL was associated with significantly increased mortality (OR 3.65; 95% CI 1.03–12.9; p = 0.04).

PCT appears promising as a surrogate biomarker for trauma. Initial peak PCT level may be used as an early predictor of sepsis, MOD, and mortality in trauma population.

• Critical care
• Injuries
• Intensive care unit
• Procalcitonin
• Prognosis
• Trauma

• Acid base changes
• Coagulopathy
• Damage control
• Lactate clearance
• Polytrauma
• Resuscitation
• Soft tissue injuries

• Blood Transfusion/statistics & numerical data
• Fracture Fixation/methods
• Fractures, Bone/surgery
• Hospitalization
• Humans
• Injury Severity Score
• Multiple Organ Failure/prevention & control
• Multiple Trauma/surgery
• Practice Guidelines as Topic
• Resuscitation/statistics & numerical data
• Time-to-Treatment/statistics & numerical data
• Trauma Centers/statistics & numerical data

• Adisintegrin-like and metalloprotease with thrombospondintype1 motif
• endothelial cell-specificmolecule
• risk stratification
• sepsis biomarkers
• von Willebrand factor

The aim of the study was to describe the prevalence of hyperlactatemia and emphasis on repeated lactate measurements in critically ill patients, and the associated mortality.

The study included 70 patients admitted in the Medical Intensive Care Unit at the Clinical Center, University of Sarajevo, in a 6-month period (July - December 2015). The following data were obtained: age, gender, reason for admission, Simplified Acute Physiology Score II, Acute Physiology and Chronic Health Evaluation, lactate concentrations upon admission, after 24 and 48 hours, and outcome (discharge from hospital or death).

Upon admission,hyperlactatemia was present in 91.4% patients with a mean concentration of lactate 4.13 ±1.21 mmol/L. Lactate concentration at 48 hours was independently associated within creased in-hospital mortality (P = 0.018).

Persistent hyperlactatemia is associated with adverse outcome in critically ill patients. Lactate concentration at 48 hours is independently associated within creased in-hospital mortality and it represents a statistically significant predictive marker of fatal outcomes of patients. Blood lactate concentrations > 2.25 mmol/L should be used by clinicians to identify patients at higher risk of death.

• critical illnesses
• fatal outcomes
• hyperlactatemia

• Burns
• Procalcitonin
• Sepsis
• Surgery

• Adult
• Aged
• Biomarkers/blood
• Burns/blood
• Burns/epidemiology
• Burns/surgery
• Female
• Humans
• Male
• Middle Aged
• Procalcitonin/blood
• Retrospective Studies
• Sepsis/blood
• Sepsis/epidemiology
• Sepsis/surgery

• Universidade de Coimbra

• IL-17
• IL-6
• Polymorphism
• Sepsis
• TNF
• Trauma

• Adult
• Biomarkers/blood
• Disease Susceptibility
• Enzyme-Linked Immunosorbent Assay
• Female
• Genotype
• Humans
• Injury Severity Score
• Intensive Care Units
• Interleukin-17/blood
• Interleukin-17/genetics
• Interleukin-6/blood
• Male
• Middle Aged
• Multiple Trauma/complications
• Prospective Studies
• Real-Time Polymerase Chain Reaction
• Sepsis/blood
• Sepsis/etiology
• Tumor Necrosis Factor-alpha/blood

• biomarkers
• burn sepsis
• cytokines
• diagnosis
• infections

• general surgery
• infection
• post-operative complications
• procalcitonin
• wounds and injuries

• Calcitonin/blood
• Humans
• Sepsis/diagnosis
• Sepsis/pathology
• Surgical Wound Infection/complications
• Wounds and Injuries/complications

• Biological markers
• Intensive care
• Sepsis
• Thioredoxins
• Trauma

• Adolescent
• Adult
• Animals
• Biomarkers/blood
• C-Reactive Protein/metabolism
• Female
• Femur/metabolism
• Femur/pathology
• Fractures, Bone/blood
• Fractures, Bone/complications
• Fractures, Bone/pathology
• Humans
• Intensive Care Units
• Male
• Sepsis/blood
• Sepsis/complications
• Sepsis/pathology
• Swine
• Thioredoxins/blood
• Wounds and Injuries/blood
• Wounds and Injuries/complications
• Wounds and Injuries/pathology

• Debridement techniques
• External fixation
• Open fractures
• Practice preferences
• Soft tissue cover
• Wound care

• Adult
• Antibiotic Prophylaxis/statistics & numerical data
• Debridement/statistics & numerical data
• Female
• Fractures, Open/therapy
• Humans
• Male
• Practice Patterns, Physicians'/statistics & numerical data
• Surveys and Questionnaires
• Therapeutic Irrigation/statistics & numerical data

• Lactate
• Mortality
• Neurotrauma
• Polytrauma
• Prognosis

• Critical Illness/mortality
• Humans
• Intensive Care Units/organization & administration
• Lactic Acid/blood
• Lactic Acid/pharmacokinetics
• Lactic Acid/therapeutic use
• Sepsis/drug therapy
• Sepsis/mortality

AIM: To investigate posttraumatic cytokine alterations and their value for predicting complications and mortality in polytraumatized patients.

METHODS: Studies on the use of specific cytokines to predict the development of complications and mortality were identified in MEDLINE, EMBASE, Web of Science and the Cochrane Library. Of included studies, relevant data were extracted and study quality was scored.

RESULTS: Forty-two studies published between 1988 and 2015 were identified, including 28 cohort studies and 14 “nested” case-control studies. Most studies investigated the cytokines interleukin (IL)-6, IL-8, IL-10 and tumor necrosis factor (TNF-α). IL-6 seems related to muliorgan dysfunction syndrome, multiorgan failure (MOF) and mortality; IL-8 appears altered in acute respiratory distress syndrome, MOF and mortality; IL-10 alterations seem to precede sepsis and MOF; and TNF-α seems related to MOF.

CONCLUSION: Cytokine secretion patterns appear to be different for patients developing complications when compared to patients with uneventful posttraumatic course. More research is needed to strengthen the evidence for clinical relevance of these cytokines.

• Multiple trauma
• Cytokine
• Acute respiratory distress syndrome
• Sepsis
• Muli-organ dysfunction syndrome
• Multi-organ failure

• SIRS
• SOFA
• clinical decision support systems
• sepsis

• Sepsis
• Trauma
• sCD163
• sIL-2Rα
• sTREM-1

Lactate clearance has been implicated as a predictor of mortality among emergency department (ED) patients with severe sepsis or septic shock. We aimed to validate prior studies showing that lactate clearance during the ED stay is associated with decreased mortality.

Retrospective dual-centered cross-sectional study using patients identified in the Yale-New Haven Hospital Emergency Medicine sepsis registry with severe sepsis or septic shock who had initial lactate levels measured in the ED and upon arrival (<24 hours) to the hospital floor. Lactate clearance was calculated as percent of serum lactate change from ED to floor measurement. We compared mortality and hospital interventions between patients who cleared lactate and those who did not.

207 patients (110 male; 63.17±17.9 years) were included. Two reviewers extracted data with 95% agreement. One hundred thirty-six patients (65.7%) had severe sepsis and 71 patients (34.3%) had septic shock. There were 171 patients in the clearance group and 36 patients in the non-clearance group. The 28-day mortality rates were 15.2% in the lactate clearance group and 36.1% in the non-clearance group (p<0.01). Vasopressor support was initiated more often in the non-clearance group (61.1%) than in the clearance group (36.8%, p<0.01) and mechanical ventilation was used in 66.7% of the non-clearance group and 36.3% of the clearance group (p=0.001).

Patients who do not clear their lactate in the ED have significantly higher mortality than those with decreasing lactate levels. Our results are confirmatory of other literature supporting that lactate clearance may be used to stratify mortality-risk among patients with severe sepsis or septic shock.

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Biomarkers/blood
• C-Reactive Protein/metabolism
• Calcitonin/blood
• Calcitonin Gene-Related Peptide
• Female
• Humans
• Interleukin-6/blood
• Male
• Middle Aged
• Monitoring, Intraoperative
• Perioperative Period
• Protein Precursors/blood
• Young Adult

• Biomarkers/analysis
• Humans
• Intensive Care Units
• Monitoring, Physiologic
• Prognosis
• Risk Assessment
• Sepsis/diagnosis
• Sepsis/physiopathology
• Sepsis/therapy

• C-reactivel protein
• neonate
• procalcitonin
• s-TREM-1
• sepsis

• Early goal-directed therapy
• Organ dysfunction
• Sepsis
• Sepsis bundles
• Shock

High mobility group box 1 (HMGB1) is a late mediator of systemic inflammation. Extracellular HMGB1 play a central pathogenic role in critical illness. The purpose of the study was to investigate the association between plasma HMGB1 concentrations and the risk of poor outcomes in patients with severe blunt chest trauma.

The plasma concentrations of HMGB1 in patients with severe blunt chest trauma (AIS ≥ 3) were measured by a quantitative enzyme-linked immunosorbent assay at four time points during seven days after admission, and the dynamic release patterns were monitored. The biomarker levels were compared between patients with sepsis and non-sepsis, and between patients with multiple organ dysfunction syndrome (MODS) and non-MODS. The related factors of prognosis were analyzed by using multivariate logistic regression analysis. The short-form 36 was used to evaluate the quality of life of patients at 12 months after injury.

Plasma HMGB1 levels were significantly higher both in sepsis and MODS group on post-trauma day 3, 5, and 7 compared with the non-sepsis and non-MODS groups, respectively. Multivariate analysis showed that HMGB1 levels and ISS were independent risk factors for sepsis and MODS in patients with severe blunt chest trauma.

Plasma HMGB1 levels were significantly elevated in patients with severe blunt chest trauma. HMGB1 levels were associated with the risk of poor outcome in patients with severe blunt chest trauma. Daily HMGB1 levels measurements is a potential useful tool in the early identification of post-trauma complications. Further studies are needed to determine whether HMGB1 intervention could prevent the development of sepsis and MODS in patients with severe blunt chest trauma.

Trauma is one of the leading causes of death worldwide. Approximately 39.5% of deaths occur in the hospital, and the mortality rate of delayed death caused by septic complications is still high. Early prediction of the development of sepsis can help promote early intervention and treatment for patients and contribute to improving patient outcomes. Thus so far, biomarkers, patient demographics and injury characteristics are the main methods used for predicting sepsis in trauma patients. However, studies that verify their predictive value are limited, and the results are still controversial. More work should be conducted to explore more efficient and accurate ways to predict post-traumatic sepsis.

• Sepsis
• infection
• prediction
• trauma

• Biological markers
• Immune monitoring
• Multiple organ failure
• Second hit
• Surgery
• Trauma

• Biomarkers/metabolism
• Cytokines/metabolism
• Fractures, Bone/complications
• Fractures, Bone/mortality
• Fractures, Bone/surgery
• Humans
• Multiple Organ Failure/etiology
• Multiple Organ Failure/immunology
• Multiple Organ Failure/mortality
• Multiple Trauma/complications
• Multiple Trauma/immunology
• Multiple Trauma/mortality
• Multiple Trauma/surgery
• Perioperative Period
• Predictive Value of Tests
• Sepsis/etiology
• Sepsis/immunology
• Sepsis/mortality
• Systemic Inflammatory Response Syndrome/etiology
• Systemic Inflammatory Response Syndrome/immunology
• Systemic Inflammatory Response Syndrome/mortality
• Treatment Outcome