Circulating levels of Clara cell protein 16 but not surfactant protein D identify and quantify lung damage in patients with multiple injuries.
BACKGROUND
Almost 60% of all patients with severe multiple injuries sustain severe chest trauma with aggravating effect on morbidity and mortality. Diagnosis of lung contusion is performed by early posttraumatic multislice computed tomography. Because this diagnostic procedure requires time, resources, and exposure to radiation, a noninvasive approach with easy follow-up measurements is warranted.


METHODS
Serum levels of Clara cell protein 16 (CC16) and surfactant protein D as lung-specific biomarkers were obtained on admission from 104 patients with multiple injuries using enzyme-linked immunosorbent assay technique. Patients were divided into those with severe lung injury ([LI]; n = 68) and without LI (NLI; n = 36). Nonsmoking healthy volunteers served as controls. In addition, volume of lung contusions were calculated planimetrically on serial multislice computed tomography scans obtained after admission. Factors influencing CC16 serum levels were determined in uni- and multivariate analyses, and Spearman rank coefficients were calculated for correlations.


RESULTS
Patients with LI showed a significant (p < 0.05) elevation of median CC16 levels (10.2 ng/mL) compared with NLI patients (5.4 ng/mL) and controls (5.2 ng/mL). Serum CC16 levels correlated with the volume of lung contusions (r = 0.78, p < 0.0001) and were not influenced by overall injury severity, age, gender, or preclinical ventilation. In contrast, circulating surfactant protein D levels were not associated with the presence of LI or the extent of lung contusions.


CONCLUSIONS
Our results advocate CC16 as a potential biomarker for LI in severely injured patients because of its high correlation with the volume of contused lung parenchyma. Therefore, this parameter may allow a specified initial treatment of patients with multiple injuries.
Department of Trauma, Hand, and Reconstructive Surgery, Hospital of the Johann Wolfgang, Goethe-University, Frankfurt, Germany. sebastian.wutzler@kgu.de
Sebastian
S
Wutzler
Thomas
T
Lehnert
Helmut
H
Laurer
Mark
M
Lehnert
Marco
M
Becker
Dirk
D
Henrich
Thomas
T
Vogl
Ingo
I
Marzi
D000328:Adult; D015415:Biomarkers / Q000097:blood*; D003288:Contusions / Q000097:blood; D004791:Enzyme Inhibitors / Q000097:blood*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D055370:Lung Injury / Q000097:blood*; D008297:Male; D009104:Multiple Trauma / Q000097:blood*; D037663:Pulmonary Surfactant-Associated Protein D / Q000097:blood*; D012372:ROC Curve; D014598:Uteroglobin / Q000097:blood*; D055815:Young Adult
D015415:Biomarkers; D004791:Enzyme Inhibitors; D037663:Pulmonary Surfactant-Associated Protein D; C556389:SCGB1A1 protein, human; D014598:Uteroglobin