CHANGES OF PROCALCITONIN LEVEL IN THE POST-TRAUMATIC PERIOD AND ITS ROLE IN SYSTEMIC RESPONSE TO TRAUMA

Procalcitonin is an important marker used in the clinical practice for sepsis diagnostics. However the increase of its concentration can be registered in the early post-traumatic period with no obvious nidus of infection. Goal: to clarify the value of procalcitonin as a biomarker in those with concurrent trauma. Methods. 76 those injured were examined and divided into subgroups depending on the severity of trauma (ISS < 20 and ISS > 20 scores) and outcome (favorable, unfavorable, with infectious complications and no infectious complications). The changes in procalcitonin level in the subgroups were compared with intensity of the systemic response to the injury through changes in IL-6, IL-8, IL-10, CD14, HLA-DR, secretory immunoglobulin A. Blood was collected upon admission to hospital, in 12 hours, on the 1st, 3rd, 7th and 10th days. Results. It has been found out that in case of concurrent trauma the procalcitonin level in blood increased immediately and it was especially intensively expressed in severe trauma (ISS > 20 scores). During first 24 hours it was tens times above the normal and it remained above the normal during the post-traumatic period. And these changes were not related to a generalized infection. During all period of follow up the changes in procalcitonin level coincided with changes in the systemic inflammatory response and anti-inflammatory and pro-inflammatory cytokines though with a certain delay. Procalcitonin level did not increase repeatedly every time as nidus of infection manifested, it occurred more often in those with lethal outcome. High procalcitonin level in the acute post-traumatic period indicated higher chances of septic complications development on the 7-10th day. Conclusion. Along with the role of procalcitonin as an infection marker, changes in its concentration in the early post-traumatic period can be considered as a laboratory sign of the intensity of systemic response to the injury.

sepsis, trauma, biomarkers, procalcitonin, secretory immunoglobulin A, bacterial translocation

1. Polushin Yu.S., Аfanasiev А.А., Malyshev M.Yu., Pivovarova L.P. Clinical and diagnostic value of procalcitonin level in those suffering with severe concurrent trauma. Vestnik Anasteziol. i Reanimatol., 2015, vol. 12, no. 1. pp. 46-54. (In Russ.)

2. Dahaba A.A., Metzler H. Procalcitonin's role in the sepsis cascade. Is procalcitonin a sepsis marker or mediator? Minerva Anestesiologica, 2008, vol. 75, no. 7-8, pp. 447-452.

3. Dandona P. et al. Procalcitonin increase after endotoxin injection in normal subjects. J. Clin. Endocrinology & Metabolism, 1994, vol. 79, no. 6, pp. 1605-1608.

4. Meisner M. Procalcitonin – a new, innovative infection parameter. Berlin, Brahms Diagnostica, 1996, pp. 3-41.

5. Whang K.T., Vath S.D., Becker K.L. et al. Procalcitonin and proinflammatory cytokine interactions in sepsis. Shock, 2000, vol. 14, no. 1, pp. 73-78.

6. Wojtaszek M., Staśkiewicz G., Torres K., Jakubowski K., Rácz O., Cipora E. Changes of procalcitonin level in multiple trauma patients. Anaesthesiology Intensive Therapy, 2014, vol. 46, no. 2, pp. 78-82.

7. Zelzer S. et al. Comparative study of the immunological marker IL-6 and the non-immunological marker PCT in surgery patients with infections and multiple trauma. Open Pathology J., 2009, vol. 3. pp. 124-130.