A role for interleukin-10 in the assessment of venous thromboembolism risk in injured patients.
BACKGROUND
Management of patients with multiple trauma requires prophylaxis for venous thromboembolism (VTE). This involves recognition of the physiologic factors that are associated with VTE risk. Currently, there is no effective strategy for risk assessment. The purpose of this study is to investigate the relationship of serum P-selectin and interleuken-10 (IL-10) with VTE as a possible physiologic marker.


METHODS
Patients admitted to two trauma centers with an Injury Severity Score >/=9 had blood samples drawn and underwent duplex ultrasound scanning of the lower extremities before initiating prophylaxis at admission, on days 3 and 7, and weekly until discharge. Patients were prophylaxed according to institutional protocols.


RESULTS
One hundred eighty-six patients were enrolled with a VTE incidence of 17.8%. The population was predominantly male (60%), with a mean age of 48 years. sP-selectin levels were not statistically different between the groups (64.4 versus 74.8 pg/mL). However, IL-10 was significantly lower in the VTE group at both the initial and subsequent blood draws (21 versus 165 ng/mL, p = 0.012). Further, the ratio of sP-selectin to IL-10 (3.92 versus 0.92, p = 0.014) was statistically higher in the VTE group at admission.


CONCLUSIONS
An elevated sP-selectin to IL-10 ratio appears to be associated with the development of VTE in patients at high risk and may prove to be a useful clinical marker for this dreaded complication among trauma patients. Early recognition of this high-risk group improves the accuracy of the risk/benefit determination for prophylaxis and identifies a group in whom routine ultrasound screening would be cost-effective.
Proctor
Mary C
MC
Section of Vascular Surgery, University of Michigan Medical Center, A. Alfred Taubman Health Care Center, 1500 E. Meedical Center Drive, Ann Arbor, MI 48109, USA. mproctor@med.umich.edu
Sullivan
Vita
V
Zajkowski
Paul
P
Wolk
Seth W
SW
Pomerantz
Richard A
RA
Wakefield
Thomas W
TW
Greenfield
Lazar J
LJ
D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006801:Humans; D016753:Interleukin-10 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000097:blood* / Q000150:complications; D019007:P-Selectin / Q000097:blood; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013923:Thromboembolism / Q000097:blood* / Q000000981:diagnostic imaging / Q000209:etiology*; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000097:blood* / Q000000981:diagnostic imaging / Q000209:etiology*
D005338:Fibrin Fibrinogen Degradation Products; D019007:P-Selectin; C036309:fibrin fragment D; D016753:Interleukin-10