title: Elevated Admission Base Deficit Is Associated with a Complex Dynamic Network of Systemic Inflammation Which Drives Clinical Trajectories in Blunt Trauma Patients.
abstract: We hypothesized that elevated base deficit (BD) ≥ 4 mEq/L upon admission could be associated with an altered inflammatory response, which in turn may impact differential clinical trajectories. Using clinical and biobank data from 472 blunt trauma survivors, 154 patients were identified after excluding patients who received prehospital IV fluids or had alcohol intoxication. From this subcohort, 84 patients had a BD ≥ 4 mEq/L and 70 patients with BD < 4 mEq/L. Three samples within the first 24 h were obtained from all patients and then daily up to day 7 after injury. Twenty-two cytokines and chemokines were assayed using Luminex™ and were analyzed using two-way ANOVA and dynamic network analysis (DyNA). Multiple mediators of the innate and lymphoid immune responses in the BD ≥ 4 group were elevated differentially upon admission and up to 16 h after injury. DyNA revealed a higher, sustained degree of interconnectivity of the inflammatory response in the BD ≥ 4 patients during the initial 16 h after injury. These results suggest that elevated admission BD is associated with differential immune/inflammatory pathways, which subsequently could predispose patients to follow a complicated clinical course.
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.
authors.forename: Othman
authors.initials: O
authors.lastname: Abdul-Malak
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA; Center for Inflammation and Regenerative Modeling, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Vodovotz
authors.affiliation: Department of Critical Care Medicine, University of Pittsburgh, PA 15213, USA.
authors.forename: Akram
authors.initials: A
authors.lastname: Zaaqoq
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.
authors.forename: Jesse
authors.initials: J
authors.lastname: Guardado
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.
authors.forename: Khalid
authors.identifier: 0000-0001-9716-3778
authors.initials: K
authors.lastname: Almahmoud
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.
authors.forename: Jinling
authors.initials: J
authors.lastname: Yin
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.
authors.forename: Brian
authors.identifier: 0000-0002-5226-1857
authors.initials: B
authors.lastname: Zuckerbraun
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Peitzman
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Sperry
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA; Center for Inflammation and Regenerative Modeling, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA.
authors.forename: Timothy R
authors.identifier: 0000-0002-2949-0811
authors.initials: TR
authors.lastname: Billiar
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA; Center for Inflammation and Regenerative Modeling, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA.
authors.forename: Rami A
authors.identifier: 0000-0002-8582-5321
authors.initials: RA
authors.lastname: Namas
mesh_terms: D000137:Acid-Base Imbalance / Q000097:blood* / Q000276:immunology*; D000704:Analysis of Variance; D018925:Chemokines / Q000097:blood / Q000378:metabolism; D016207:Cytokines / Q000097:blood / Q000378:metabolism; D005260:Female; D006760:Hospitalization; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D014947:Wounds and Injuries / Q000097:blood* / Q000276:immunology*; D014949:Wounds, Nonpenetrating / Q000097:blood / Q000276:immunology
chemical_list: D018925:Chemokines; D016207:Cytokines