Relationship of serum C-reactive protein and blood glucose levels with injury severity and patient morbidity in a pediatric trauma population.
OBJECTIVE
Serum markers of inflammation and of glucose production are known to reflect the immediate metabolic response to injury. We hypothesized that monitoring of the early C-reactive protein (CRP) and blood glucose (BG) concentrations would correlate with clinical morbidity and outcome measures in pediatric trauma patients.


METHODS
A five-year retrospective chart review of pediatric trauma patients admitted to our Level I pediatric trauma center was conducted to establish the relationships between early (first 3 hospital days) serum CRP and BG concentrations, Injury Severity Score (ISS), and hospital length of stay (HLOS). Statistical significance (P < 0.05) was determined using Student's t-test.


RESULTS
Forty-two trauma patients (8.0 +/- 5.2 years) were evaluated. The early inflammatory response (CRP >or= 10 vs <10 mg/dl) was significantly correlated to the glycemic response (BG;121 +/- 24 vs 97.3 +/- 14.2 mg/dl, P < 0.05). Severely injured patients (ISS >or= 25 vs <25) were significantly more hyperglycemic (BG;156 +/- 56.9 vs 125 +/- 31.6 mg/dL, P = 0.003). Both increased inflammatory response (CRP;8.1 +/- 6.4 vs 2.5 +/- 3.5 mg/dL) and increased glycemic response (BG;111 +/- 15.9 vs 97.4 +/- 11.7 mg/dL) were independently and significantly associated with prolonged hospitalization (HLOS > 7 vs <or=7 days, P < 0.05).


CONCLUSIONS
This study establishes a significant relationship between the early inflammatory and glycemic injury response and the association of that response with pediatric trauma patient morbidity and outcome measures.
Division of Pediatric Surgery, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
Lisa N
LN
Brunengraber
Ann V
AV
Robinson
Walter J
WJ
Chwals
D000210:Acute-Phase Reaction; D000293:Adolescent; D015415:Biomarkers; D001786:Blood Glucose / Q000032:analysis*; D002097:C-Reactive Protein / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay / Q000706:statistics & numerical data; D008099:Liver / Q000378:metabolism; D008297:Male; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000097:blood* / Q000503:physiopathology
D015415:Biomarkers; D001786:Blood Glucose; D002097:C-Reactive Protein