Alpha-melanocyte stimulating hormone in critically injured trauma patients.
BACKGROUND
Alpha-melanocyte stimulating hormone (alpha-MSH) is a neuropeptide which modulates inflammation. Prior studies have documented decreased alpha-MSH concentrations in patients with acute traumatic brain injury and subarachnoid hemorrhage. We hypothesized that alpha-MSH levels would be decreased in critically injured patients and that this would correlate with poor outcome.


METHODS
We performed a retrospective review of prospectively collected data more than 12 months ending December 2005. alpha-MSH concentrations were measured in major torso trauma patients (excluding severe head injuries) who underwent standardized shock resuscitation. alpha-MSH concentrations were measured every 4 hours for the first 24 hours of intensive care unit admission and daily thereafter for hospital days 2 to 5. Controls were similarly aged, healthy volunteers. Outcomes measured included lengths of stay, infectious morbidity, and the incidence of multiple organ failure (MOF) and mortality.


RESULTS
Fifty-one trauma patients were studied with a median age of 33 (22-54) years. Seventy-five percent were male and 82% sustained blunt trauma. The median Injury Severity Score was 25 (16-34). Eighteen percent of the patients developed MOF, 18% died, and 24% developed MOF and died. The mean initial (first value on the first day) alpha-MSH concentration was significantly lower than in controls (15.9 pg/mL +/- 7.6 pg/mL vs. 26.1 pg/mL +/- 7.4 pg/mL, p = 0.0008) and did not change significantly during the 5-day study period. On univariate and adjusted multivariate analyses, initial alpha-MSH concentrations did not predict either MOF or mortality.


CONCLUSIONS
The current study is the first to document significantly decreased alpha-MSH concentrations in critically injured trauma patients as compared with controls. Furthermore, alpha-MSH concentrations remained so throughout the study period.
Todd
S Rob
SR
Department of Surgery, Weill Medical College of Cornell University, Houston, Texas 77030, USA. srtodd@tmh.tmc.edu
Kao
Lillian S
LS
Catania
Anna
A
Mercer
David W
DW
Adams
Sasha D
SD
Moore
Frederick A
FA
D000328:Adult; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D016638:Critical Illness; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality; D009104:Multiple Trauma / Q000097:blood* / Q000401:mortality; D012044:Regression Analysis; D012189:Retrospective Studies; D000521:alpha-MSH / Q000097:blood*
D000521:alpha-MSH