title: Admission biomarkers of trauma-induced secondary cardiac injury predict adverse cardiac events and are associated with plasma catecholamine levels.
abstract: BACKGROUND
  Secondary cardiac injury and dysfunction may be important contributors to poor outcomes in trauma patients, but the pathophysiology and clinical impact remain unclear. Early elevations in cardiac injury markers have been associated with the development of adverse cardiac events (ACEs), prolonged intensive care unit stays, and increased mortality. Studies of preinjury β-blocker use suggest a potential protective effect in critically ill trauma patients. This study aimed to prospectively examine the association of early biomarker evidence of trauma-induced secondary cardiac injury (TISCI) and ACEs and to examine the potential contribution of circulating catecholamines to its pathophysiology.
  
  
  METHODS
  Injured patients who met the study criteria were recruited at a single major trauma center. A blood sample was collected immediately on arrival. Serum epinephrine (E), norepinephrine (NE), and cardiac biomarkers including heart-related fatty acid binding protein (H-FABP) were assayed. Data were prospectively collected on ACEs.
  
  
  RESULTS
  Of 300 patients recruited, 38 (13%) developed an ACE and had increased mortality (19% vs. 9%, p = 0.01) and longer intensive care unit stays (13 days, p < 0.001). H-FABP was elevated on admission in 56% of the patients, predicted the development of ACE, and was associated with higher mortality (14% vs. 5%, p = 0.01). Admission E and NE levels were strongly associated with elevations in H-FABP and ACEs (E, 274.0 pg/mL vs. 622.5 pg/mL, p < 0.001; NE, 1,063.2 pg/mL vs. 2,032.6 pg/mL, p < 0.001). Catecholamine effect on the development of TISCI or ACEs was not statistically independent of injury severity or depth of shock.
  
  
  CONCLUSIONS
  Admission levels of H-FABP predict the development of ACEs and may be useful for prognosis and stratification of trauma patients. The development of TISCI and ACEs was associated with high admission levels of catecholamines, but their role in pathogenesis remains unclear. Clinical trials of adrenergic blockade may have the potential to demonstrate outcomes in patients presenting with TISCI.
  
  
  METHODS
  Prognostic/epidemiologic study, level II.
authors.affiliation: From the Centre for Trauma Sciences, Queen Mary University of London, London, United Kingdom.
authors.forename: Sriveena
authors.initials: S
authors.lastname: Naganathar
authors.forename: Henry D
authors.initials: HD
authors.lastname: De'Ath
authors.forename: Johanna
authors.initials: J
authors.lastname: Wall
authors.forename: Karim
authors.initials: K
authors.lastname: Brohi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002395:Catecholamines / Q000097:blood*; D006335:Heart Injuries / Q000097:blood* / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D014947:Wounds and Injuries / Q000097:blood* / Q000150:complications* / Q000503:physiopathology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002395:Catecholamines