title: Club cell protein 16 and cytokeratin fragment 21-1 as early predictors of pulmonary complications in polytraumatized patients with severe chest trauma.
abstract: BACKGROUND
  Acute respiratory distress syndrome (ARDS) and pneumonia have a great impact on the treatment regimen of polytraumatized patients with severe chest trauma. The objective of our study was to determine whether biomarker levels assessed shortly after multiple trauma may predict the occurrence of these conditions.
  
  
  RESULTS
  Our patient population included 71 men and 30 women (mean age, 40.3 ± 15.8 years) with an Injury Severity Score that ranged from 17 to 59 and an Abbreviated Injury Scale Thorax of at least 3. They were admitted to our level I trauma center within one post-traumatic hour and survived for at least 24 hours after the trauma occurred. Thirty-five patients developed ARDS, 30 patients pneumonia and 21 patients both. Five individuals died during hospitalization. The levels of five selected biomarkers, which were identified by a literature search, were assessed at admission (initial levels) and on day 2 after trauma. We performed comparisons of medians, logistic regression analyses and receiver operating characteristic analyses for initial and day-2 levels of each biomarker. With regard to ARDS, initial levels of cytokeratin fragment 21-1, the soluble fragment of cytokeratin 19 (CYFRA21-1) and of the club cell protein 16 (CC16) provided significant results in each statistical analysis. With regard to pneumonia, each statistical analysis supplied significant results for both initial and day-2 levels of CYFRA21-1 and CC16. Consistently, initial CYFRA21-1 levels were identified as the most promising predictor of ARDS, whereas day-2 CC16 levels have to be considered as most appropriate for predicting pneumonia.
  
  
  CONCLUSIONS
  CYFRA21-1 levels exceeding cut-off value of 1.85 ng/ml and 2.49 ng/ml in the serum shortly after multiple injury occurred may identify polytraumatized patients at risk for ARDS and pneumonia, respectively. However, CC16 levels exceeding 30.51 ng/ml on day 2 may allow a firmer diagnosis for the development of pneumonia.
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Lukas L
authors.identifier: http://orcid.org/0000-0002-7195-2223
authors.initials: LL
authors.lastname: Negrin
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Halat
authors.affiliation: Department of Anesthesiology, General Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria.
authors.forename: Stephan
authors.initials: S
authors.lastname: Kettner
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Markus
authors.initials: M
authors.lastname: Gregori
authors.affiliation: Center for Medical Statistics and Informatics, Medical University of Vienna, Vienna, Austria.
authors.forename: Robin
authors.initials: R
authors.lastname: Ristl
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hajdu
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Heinz
mesh_terms: D015998:Abbreviated Injury Scale; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000951:Antigens, Neoplasm / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D053539:Keratin-19 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications*; D011014:Pneumonia / Q000209:etiology*; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D013898:Thoracic Injuries / Q000150:complications*; D014598:Uteroglobin / Q000097:blood*; D055815:Young Adult
chemical_list: D000951:Antigens, Neoplasm; D015415:Biomarkers; D053539:Keratin-19; C556389:SCGB1A1 protein, human; C102012:antigen CYFRA21.1; D014598:Uteroglobin