Objective To explore the change of serum levels of neutrophil gelatinase-associated lipocalin (NGAL), tissue inhibitor of metalloproteinases-2 (TIMP-2), and insulin-like growth factor-binding protein 7 (IGFBP-7) in the early stage of multiple trauma, and their predictive efficacy for acute kidney injury (AKI). Methods The multiple trauma patients admitted between February 2020 and July 2021 were prospectively selected, and they were divided into AKI group and non-AKI group according to whether they developed AKI within 72 h after injury. The serum levels of NGAL, TIMP-2, and IGFBP-7 measured at admission and 12, 24, and 48 h after injury, the Acute Pathophysiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) score, intensive care unit duration, rate of renal replacement therapy, and 28-day mortality rate were compared between the two groups. Results A total of 51 patients were included, including 20 in the AKI group and 31 in the non-AKI group. The APACHE Ⅱ at admission (20.60±3.57 vs. 11.61±3.44), intensive care unit duration [(16.75±2.71) vs. (11.13±3.41) d], rate of renal replacement therapy (35.0% vs. 0.0%), and 28-day mortality rate (25.0% vs. 3.2%) in the AKI group were higher than those in the non-AKI group (P<0.05). The serum levels of NGAL and IGFBP-7 at admission and 12, 24, and 48 h after injury in the AKI group were all higher than those in the non-AKI group (P<0.05). For the prediction of AKI, the areas under receiver operating characteristic curves and 95% confidence intervals of serum NGAL, TIMP-2 and IGFBP-7 12 h after injury were 0.98 (0.96, 1.00), 0.92 (0.83, 1.00), and 0.87 (0.78, 0.97), respectively. Conclusion Serum NGAL, TIMP-2, and IGFBP-7 have high predictive efficacy for AKI secondary to multiple trauma, and continuous monitoring of serum NGAL can be used for early prediction of AKI secondary to multiple trauma.
Objective To investigate the dynamic expression and clinical significance of myoglobin, creatine kinase and inflammatory mediators in the serum of patients with multiple trauma. Methods From May 2013 to March 2015, 56 patients with multiple trauma admitted in EICU were recruited in the study. According to the injury severity, 56 patients were divided into a mild trauma group, a medium trauma group and a severe trauma group. The subjects were further divided into a MODS group and a non-MODS group based on multiple organ dysfunction syndrome (MODS) criteria. Twenty healthy adults undergoing physical examination were recruited as control. Serum myoglobin, creatine kinase, IL-6 and TNF-α levels were measured in the multiple trauma patients (1st day, 3rd day, 7th day and 14th day) and the controls. Results Compared with the controls, the serum levels of myoglobin, creatine kinase, IL-6 and TNF-α in the patients with multiple trauma increased significantly from 1st to 14th day after injury (allP＜0.05). Serum myoglobin, creatine kinase, IL-6 and TNF-α levels on 3rd day after injury reached the peak, then decreased gradually in the mild, medium, and severe trauma groups, among which the changes of serum myoglobin, creatine kinase, IL-6 and TNF-α levels were significant on 3rd day compared with other timepoints (allP＜0.05). On 1st day after injury, serum levels ofmyoglobin, creatine kinase, IL-6 and TNF-α also differed significantly between the MODS group and non-MODS group (allP＜0.05). The AUCs of myoglobin, IL-6 and TNF-α for predicting MODS were 0.527-0.817, 0.641-0.890, and 0.197-0.544, respectively. Conclusions The dynamic changes of serum myoglobin, creatine kinase, IL-6 and TNF-α in patients with multiple trauma are correlated well with the injury severity and prognosis. Serum myoglobin, IL-6 and TNF-α levels may be good markers to predict secondary MODS in multiple trauma patients.
Objective To investigate the percentage of CD4+CD25+ Treg in peripheral blood of patients with severe multiple trauma and systemic inflammatory response syndrome（SIRS） and its effects on cellular immunity and secondary infection.Metheds Peripheral blood of 23 patients with severe multiple trauma was collected in 24 h after SIRS was diagnosed，and flow cytometry was used to determine the percentage of CD4+CD25+ Treg and CD4/CD8 ratio.Simultaneously，in order to explore the cell proliferation，silver staining was used to determine Ag-NORs of leukomonocyte in peripheral blood represented by IS%.In order to investigate the infection in patients，sputum and secretion sample were collected for bacteriological examination on 1 and 5 day after SIRS was established.Forty healthy volunteers were enrolled as control.Results Compared with the control，the percentage of CD4+CD25+ Treg was significant higher[（14.21±3.43）% vs（9.53±3.22），Plt;0.01] and the ratio of CD4/CD8 and IS% were significant lower in patients with severe multiple trauma[（5.94±0.66）% vs（6.74±0.95）%，（1.22±0.25）% vs（1.72±0.36）%，respectively，both Plt;0.01].In those patients（n=14） who developed secondary infection，Treg% was significant higher [（18.69±4.21）% vs（12.58±2.49）%，Plt;0.01]，while IS% and CD4/CD8 were significant lower [（5.79±0.68）% vs（6.15±0.57）%，（1.15±0.25）% vs（1.39±0.25）%，both Plt;0.01].compared to the patients without secondary infection Conlusion CD4+CD25+ Treg is valuable to estimate the cellular immunity and predict secondary infection in patients with severe multiple trauma.
Objective To investigate the correlation between the activation of peripheral blood neutrophil extracellular traps (NETs), oxidative stress levels, and the risk of developing acute respiratory distress syndrome (ARDS) in patients with multiple trauma, thereby providing a basis for the early prediction and intervention of post-traumatic ARDS. Methods This prospective cohort study enrolled 168 patients with multiple trauma admitted to our hospital between February 2023 and September 2025. Peripheral venous blood was collected within 24 hours of admission and on day 3 after treatment initiation. Plasma levels of NETs markers [neutrophil elastase (NE), citrullinated histone H3 (CitH3), myeloperoxidase (MPO)] and oxidative stress indicators [malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx)] were measured. All patients were followed for 28 days post-admission and were categorized into ARDS and non-ARDS groups based on ARDS occurrence during follow-up. Univariate analysis, multivariate logistic regression analysis, and receiver operating characteristic (ROC) curve analysis were used to assess the correlation and predictive value of NETs and oxidative stress levels for ARDS risk. Results All 168 patients completed the 28-day follow-up. During follow-up, 42 patients (25.0%) developed ARDS. The ARDS group had significantly higher ISS scores, longer mechanical ventilation duration, and a higher proportion of surgical interventions, but lower Glasgow Coma Scale (GCS) scores at admission compared to the non-ARDS group (all P<0.05). At both 24 hours post-admission and on day 3 post-treatment, the ARDS group exhibited significantly higher levels of NE, CitH3, MPO, and MDA, and significantly lower levels of SOD and GPx compared to the non-ARDS group (all P<0.05). By day 3 post-treatment, levels of the aforementioned NETs markers and MDA had decreased, while SOD and GPx levels had increased in both groups; however, the magnitude of improvement was significantly smaller in the ARDS group (all P<0.05). Repeated measures ANOVA revealed statistically significant "time × group" interaction effects for NE, CitH3, MPO, MDA, SOD, and GPx levels (all P<0.05). Multivariate logistic regression analysis identified higher levels of NE, CitH3, MPO, and MDA at 24 hours post-admission as independent risk factors for ARDS, while higher levels of SOD and GPx at the same timepoint were independent protective factors (P<0.05). ROC analysis showed that the combination of plasma NE, CitH3, MPO, MDA, SOD, and GPx levels at 24 hours post-admission predicted ARDS risk with an AUC of 0.811 (95%CI: 0.728-0.895), which was significantly superior to the predictive efficacy of any single indicator alone (Z=3.344, 3.391, 3.069, 2.208, 2.794, 2.021, respectively; all P<0.05). Conclusion Enhanced peripheral blood NETs activation and oxidative stress imbalance are closely associated with an increased risk of ARDS in patients with multiple trauma. NE, CitH3, MPO, MDA, SOD, GPx are independent influencing factors for ARDS risk. Combined dynamic monitoring of these indicators can effectively enhance the predictive power for ARDS risk.