title: Clinical and biomarker profile of trauma-induced secondary cardiac injury.
abstract: BACKGROUND
  Secondary cardiac injury has been demonstrated in critical illness and is associated with worse outcomes. The aim of this study was to establish the existence of trauma-induced secondary cardiac injury, and investigate its impact on outcomes in injured patients.
  
  
  METHODS
  Injured adult patients eligible for enrolment in the Activation of Coagulation and Inflammation in Trauma 2 study, and admitted to the intensive care unit between January 2008 and January 2010, were selected retrospectively for the study. Markers of cardiac injury (brain natriuretic peptide (BNP), heart-type fatty acid binding protein (H-FABP) and troponin I) were measured on admission, and after 24 and 72 h in blood samples from injured patients. Individual records were reviewed for adverse cardiac events and death.
  
  
  RESULTS
  During the study period, 135 patients were enrolled (106 male, 78·5 per cent) with a median age of 40 (range 16-89) years. Eighteen patients (13·3 per cent) had an adverse cardiac event during admission and these events were not associated with direct thoracic injury. The in-hospital mortality rate was higher among the adverse cardiac event cohort: 44 per cent (8 of 18) versus 17·1 per cent (20 of 117) (P = 0·008). Raised levels of H-FABP and BNP at 0, 24 and 72 h, and troponin I at 24 and 72 h, were associated with increased adverse cardiac events. BNP levels were higher in non-survivors on admission (median 550 versus 403 fmol/ml; P = 0·022), after 24 h (794 versus 567 fmol/ml; P = 0·033) and after 72 h (1043 versus 753 fmol/ml; P = 0·036), as were admission troponin I levels.
  
  
  CONCLUSIONS
  Clinical and cardiac biomarker characteristics support the existence of trauma-induced secondary cardiac injury, which is associated with death, and unrelated to direct thoracic injury.
authors.affiliation: Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK. henryde-ath@doctors.org.uk
authors.forename: H D
authors.initials: HD
authors.lastname: De'Ath
authors.forename: C
authors.initials: C
authors.lastname: Rourke
authors.forename: R
authors.initials: R
authors.lastname: Davenport
authors.forename: J
authors.initials: J
authors.lastname: Manson
authors.forename: I
authors.initials: I
authors.lastname: Renfrew
authors.forename: R
authors.initials: R
authors.lastname: Uppal
authors.forename: L C
authors.initials: LC
authors.lastname: Davies
authors.forename: K
authors.initials: K
authors.lastname: Brohi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000378:metabolism*; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000209:etiology*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011446:Prospective Studies; D019210:Troponin I / Q000097:blood*; D014947:Wounds and Injuries / Q000150:complications*; D055815:Young Adult
chemical_list: D015415:Biomarkers; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; D010446:Peptide Fragments; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain