Elevation of neutrophil-derived factors in patients after multiple trauma.

Trauma represents one of the leading causes of death worldwide. Traumatic injuries elicit a dynamic inflammatory response with systemic release of inflammatory cytokines. Disbalance of this response can lead to systemic inflammatory response syndrome or compensatory anti-inflammatory response syndrome. As neutrophils play a major role in innate immune defence and are crucial in the injury-induced immunological response, we aimed to investigate systemic neutrophil-derived immunomodulators in trauma patients. Therefore, serum levels of neutrophil elastase (NE), myeloperoxidase (MPO) and citrullinated histone H3 (CitH3) were quantified in patients with injury severity scores above 15. Additionally, leukocyte, platelet, fibrinogen and CRP levels were assessed. Lastly, we analysed the association of neutrophil-derived factors with clinical severity scoring systems. Although the release of MPO, NE and CitH3 was not predictive of mortality, we found a remarkable increase in MPO and NE in trauma patients as compared with healthy controls. We also found significantly increased levels of MPO and NE on Days 1 and 5 after initial trauma in critically injured patients. Taken together, our data suggest a role for neutrophil activation in trauma. Targeting exacerbated neutrophil activation might represent a new therapeutic option for critically injured patients.

Musculus psoas major morphology - a novel predictor of mortality in elderly polytraumatized patients.

INTRODUCTION: Numerous papers in different fields have already shown that CT imaging of the Musculus Psoas Major (MPM) can be used to predict patient outcome. Unfortunately, most of the methods presented in the literature are very complex and not easy to perform in the clinic. Therefore, the objectives of the study were to introduce a novel and convenient method for measuring the MPM to trauma surgeons and to prove the association between MPM morphology and mortality in elderly polytraumatized patients. MATERIAL AND METHODS: The retrospective outcome study was conducted at our level I trauma center. All patients admitted from 2006 to 2020 were included if they (1) presented with multiple injuries (≥2 body regions) and an Injury Severity Score (ISS) ≥16, (2) were at least 65 years of age, and (3) were diagnosed using a whole-body computed tomography. Subsequently, the ratios of short-axis to long-axis of both MPM were measured, and their mean value was evaluated as a candidate predictor of 31-day mortality. RESULTS: Our study group consisted of 158 patients (63.3% male; median age, 76 years; median ISS, 25). In the survivors (55.7%), the mean MPM score was significantly higher compared to the fatalities (0.57 versus 0.48; p < 0.0001). Multivariate binary logistic regression analysis identified the MPM score as a protective predictor of 31 day-mortality (OR = 0.92, p < 0.001), whereas age (OR 1.08, p = 0.002 and ISS (OR 1.06, p = 0.006) revealed as significant risk factors for mortality. ROC statistics provided an AUC = 0.724 (p < 0.0001) and a cut-off level of 0,48 (sensitivity, 80.7%; specificity, 54.3%). CONCLUSION: The present study demonstrated that MPM score levels lower than 0.48 might be considered an additional tool to identify elderly patients at high risk of death following major trauma. In our opinion, the assessment of the MPM score is an easy, convenient, and intuitive method to gain additional information quickly after admission to the hospital that could be implemented without great effort into daily clinical practice.

Outcomes of coronary artery bypass grafting in patients with human immunodeficiency virus infection.

BACKGROUND: With early and effective antiretroviral therapy and improved survival for persons living with human immunodeficiency virus infection (PLHIV), this patient population now faces an increasingly elevated risk of cardiovascular disease. However, the data on outcomes after coronary artery bypass grafting (CABG) for revascularization of coronary artery disease (CAD) in HIV+ patients is limited. METHODS: We conducted a retrospective analysis of 16 patients undergoing isolated CABG at the Medical University of Vienna from 2005 to 2018, who were HIV+ on admission. The primary endpoint of the study was survival. Secondary endpoints included the components of major adverse cardiac and cerebrovascular events (MACCE): cardiovascular death, stroke, myocardial infarction (MI), and repeat revascularization. RESULTS: Patients were followed for a median of 49 months (range, 7-142 months). Survival was 100% and 90% at 1 and 3 years after CABG, respectively. There were no strokes. MI and subsequent repeat revascularization were observed in two patients. CONCLUSION: CABG provides excellent short- and midterm survival and freedom from MACCE in HIV+ patients with CAD requiring revascularization.

Differences in Eotaxin Serum Levels between Polytraumatized Patients with and without Concomitant Traumatic Brain Injury-A Matched Pair Analysis.

Background/Objectives: Early detection of traumatic brain injury (TBI) is crucial for minimizing secondary neurological damage. Our study aimed to assess the potential of IL-4, IL-6, IL-7, IL-8, IL-10, TNF, and eotaxin serum levels-as a single clinical tool or combined into a panel-for diagnosing TBI in multiple injured patients. Methods: Out of 110 prospectively enrolled polytrauma victims (median age, 39 years; median ISS, 33; 70.9% male) admitted to our level I trauma center over four years, we matched 41 individuals with concomitant TBI (TBI cohort) to 41 individuals without TBI (non-TBI cohort) based on age, gender, Injury Severity Score (ISS), and mortality. Patients' protein levels were measured upon admission (day 0) and on days 1, 3, 5, 7, and 10 during routine blood withdrawal using one separation gel tube each time. Results: The median serum levels of IL-4, IL-6, IL-7, IL-8, IL-10, and TNF exhibited non-similar time courses in the two cohorts and showed no significant differences on days 0, 1, 3, 5, and 7. However, the median eotaxin levels had similar trend lines in both cohorts, with consistently higher levels in the TBI cohort, reaching significance on days 0, 3, and 5. In both cohorts, the median eotaxin level significantly decreased from day 0 to day 1, then significantly increased until day 10. We also found a significant positive association between day 0 eotaxin serum levels and the presence of TBI, indicating that for every 20 pg/mL increase in eotaxin level, the odds of a prevalent TBI rose by 10.5%. ROC analysis provided a cutoff value of 154 pg/mL for the diagnostic test (sensitivity, 0.707; specificity, 0.683; AUC = 0.718). Conclusions: Our findings identified the brain as a significant source, solely of eotaxin release in humans who have suffered a TBI. Nevertheless, the eotaxin serum level assessed upon admission has limited diagnostic value. IL-4, IL-6, IL-7, IL-8, IL-10, and TNF do not indicate TBI in polytraumatized patients.