Trauma stimulates the synthesis of Gc-globulin.
OBJECTIVE
Actin is the dominating intracellular protein and is released to the circulation after tissue injury. Gc-globulin is one of the plasma proteins responsible for removal of actin from the circulation. Recent studies have shown that the level of Gc-globulin is reduced shortly after trauma. Serial changes in Gc-globulin after severe injury have not been studied so far and could provide additional information about the role of Gc-globulin in the pathophysiological response to trauma.


METHODS
Prospective, observational.


METHODS
Surgical intensive care unit in a university hospital.


METHODS
Thirty-eight patients were included in the study: 12 women and 26 men with a median age of 38 years (range 19-86) and a median Injury Severity Score (ISS) of 18 (range 6-45). Seven patients died, on day 5, 8, 8, 10, 10, 13 and 21, respectively.


METHODS
None.


RESULTS
The serum concentration of Gc-globulin (Gctotal) and the percentage of Gc-globulin bound to actin (Gc%complexed) were measured daily for 1 week using rocket immunoelectrophoresis. Concentrations of free Gc-globulin (Gcfree) and Gc-globulin bound to actin (Gcbound) were calculated from these analytical results. The concentration of Gctotal and Gccomplexed correlated significantly (r = -0.99, p < 0.001) throughout the time period. After day 3 levels of Gc%complexed normalised, whereas levels of Gctotal continued to increase above control values. The concentrations of Gctotal and Gcfree were significantly lower in non-survivors compared to survivors; p = 0.005 and p = 0.03, respectively. This was combined with an inverse correlation of Gcbound between these two groups (r = -0.73; p = 0.04).


CONCLUSIONS
Severe injury results in a prolonged load on the extracellular actin scavenger system; more pronounced in patients who do not survive. Gc-globulin displays characteristics of an acute phase reactant, with supra-normal serum levels 1 week after severe injury. Serial measurements of Gc-globulin after trauma could prove to be a method of early identification of patients with increased risk of mortality.
Dahl
B
B
Department of Orthopaedic Surgery, Rigshospitalet, University Hospital of Copenhagen, 9 Blegdamsvej, Copenhagen, 2100 Denmark. bd@image.dk
Schiødt
F V
FV
Rudolph
S
S
Ott
P
P
Kiaer
T
T
Heslet
L
L
D000199:Actins / Q000097:blood*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007122:Immunoelectrophoresis; D015601:Injury Severity Score; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000097:blood* / Q000401:mortality / Q000503:physiopathology; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D014809:Vitamin D-Binding Protein / Q000096:biosynthesis* / Q000097:blood
D000199:Actins; D014809:Vitamin D-Binding Protein