Early serum procalcitonin, interleukin-6, and 24-hour lactate clearance: useful indicators of septic infections in severely traumatized patients.
BACKGROUND
Elevated lactate and interleukin-6 (IL-6) levels were shown to correlate with mortality and multiple organ dysfunction in severely traumatized patients. The purpose of this study was to test whether an association exists between 24-hour lactate clearance, IL-6 and procalcitonin (PCT) levels, and the development of infectious complications in trauma patients.


METHODS
A total of 1757 consecutive trauma patients with an Injury Severity Score (ISS) > 16 admitted over a 10-year period were retrospectively analyzed over a 21-day period. Exclusion criteria included death within 72 h of admission (24.5%), late admission > 12 h after injury (16%), and age < 16 years (0.5%). Data are stated as the median (range).


RESULTS
Altogether, 1032 trauma patients (76.2% male) with an average age of 38 years, a median ISS of 29 (16-75), and an Acute Physiology, Age, and Chronic Health Evaluation (APACHE) II score of 14 (0-40) were evaluated. The in-hospital mortality (>3 days) was 10%. Patients with insufficient 24-hour lactate clearance had a high rate of overall mortality and infections. Elevated early serum procalcitonin on days 1 to 5 after trauma was strongly associated with the subsequent development of sepsis (p < 0.01) but not with nonseptic infections. The kinetics of IL-6 were similar to those of PCT but did differentiate between infected and noninfected patients after day 5.


CONCLUSIONS
This study demonstrates that elevated early procalcitonin and IL-6 levels and inadequate 24-hour lactate clearance help identify trauma patients who develop septic and nonseptic infectious complications. Definition of specific cutoff values and early monitoring of these parameters may help direct early surgical and antibiotic therapy and reduce infectious mortality.
Billeter
Adrian
A
Division of Trauma Surgery, Department of Surgery, University of Zürich Hospital, Rämistrasse 100, Zurich CH-8091, Switzerland. adrianbilleter@bluewin.ch
Turina
Matthias
M
Seifert
Burkhardt
B
Mica
Ladislav
L
Stocker
Reto
R
Keel
Marius
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D015850:Interleukin-6 / Q000097:blood*; D019344:Lactic Acid / Q000097:blood*; D007902:Length of Stay; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011498:Protein Precursors / Q000097:blood*; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood* / Q000209:etiology / Q000401:mortality; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000097:blood* / Q000150:complications / Q000401:mortality; D055815:Young Adult
D015415:Biomarkers; C000606589:CALCA protein, human; D015850:Interleukin-6; D011498:Protein Precursors; D019344:Lactic Acid; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide