Kompendium 2020 Forschung & Klinik

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40
tPA Serum Antigen Levels Predict
ARDS in Polytraumatized Patients
Acute respiratory distress syndrome (ARDS) is a highly lifethreatening,
clinically defined, heterogeneous condition, regarding
both etiology and clinical course, which is triggered by
either a direct or an indirect insult to the lung, causing epithelial
and endothelial injuries. A variety of cellular and molecular
mechanisms contribute to the complex pathophysiology of ARDS,
including inflammation-induced coagulation and reduced fibrinolysis,
which favor excessive intra-alveolar fibrin deposition.
„The choice of the right treatment
strategy for polytraumatized patients
has to be based on an individual
risk stratification. The ambition of
contributing to the implementation
of a personalized polytrauma care
encouraged me to establish the
research group ‚Biomarkers‘ in 2011.“
Lukas Negrin
Study:
Negrin LL, Dedeyan M, Plesser
S, Hajdu S. Impact of Polytrauma
and Acute Respiratory
Distress Syndrome on Markers
of Fibrinolysis: A Prospective
Pilot Study. Front Med
(Lausanne). 2020 Jun 2;7:194.
ARDS is a common complication in polytrauma victims, particularly in
those with chest injuries, and a major cause of mortality and morbidity.
Its development is difficult to anticipate, as candidate biomarkers for the
prediction of ARDS were found not to be reliable for clinical use. By assessing
the time-dependent course of the serum antigen levels of the tissue
plasminogen activator (tPA) and the plasminogen activator inhibitor type-1
(PAI-1), which are both thought to reflect endothelial damage, we strived to
identify a cut off value or a clear curve characteristic that might predict the
development of ARDS in polytraumatized patients.
Our prospective study enrolled 28 consecutive blunt polytrauma survivors
(mean age, 38.4 [18-85] years; mean ISS, 35.1 [21-50]), who were directly
admitted to our level I trauma center within one year and transferred to the
ICU after initial treatment fulfilling the inclusion criteria minimum age of 18
years (1), Injury Severity Score (ISS) equal or higher than 16 (2), no anticoagulant
medication before trauma (3), and no treatment with tranexamic acid
(4) to avoid hyperfibrinolysis. To investigate the natural history of biomarker
levels, blood samples for tPA and PAI-1 analysis using Luminex multi-analyte
technology were taken at admission (day 0) and on days 1, 3, 5, 7, 10, 14,
and 21 during hospitalization, as long as the patient consented. Ten healthy
adults, who had responded our call for volunteers, were combined to our
control group. Only one blood sample was taken from them. Mann-Whitney
U-test, Chi-square test, and Wald test were performed to reveal significant
differences (p 3-fold higher than the mean level of the healthy control
group. After decreasing by 36% from day 0 to day 3 (p = 0.004), it basically
remained stable for up to 21 days (included).