Relationship Between Hbp And Severity Of Multiple Trauma And Its Predictive Value For Post-trauma MODs

Objective:Multiple trauma is one of the most challenging critical diseases in clinical treatment.Although the improvement of medicine has enabled patients to maintain early life,the acute inflammatory caused by trauma itself in the early stage or exacerbated by subsequent invasive infection,makes patients face serious complications after trauma,especially multiple organ failure.Elucidating the complex pathogenesis of inflammatory factors can effectively improve the treatment.Heparin-binding protein(HBP)is a 37 kda cationic antibacterial protein,which is produced by the degranulation of activated polymorphonuclear leukocytes(PMNs)with a stimulation by a variety of factors.HBP plays a role in increasing vascular permeability and inflammatory cell chemotaxis after rapid release.As a biomarker,HBP is often used as an indicator of infection and is an important inflammatory factor.In terms of body injury,although some studies have shown that HBP in non-infectious diseases such as lung injury,burns,and surgery and so on have clinical significane,but the study of HBP on multiple trauma is still lack.This study aims to explore the relationship between HBP and the severity of trauma in patients with multiple trauma,and the predictive occurrence and prognostic value of MODS after trauma.Methods:According to the inclusion and exclusion criteria,97 patients with multiple trauma who visited the emergency department of the First Hospital of Shanxi Medical University from November 2021 to November 2022 were enrolled,and 30 healthy volunteers were collected during the same period.According to the ISS score of patients with multiple trauma,ISS<16 were divided into minor trauma group,16≤ISS<25 were divided into serious trauma group,ISS≥25 were classified into severe trauma group.The baseline data and serum HBP concentration were compared between healthy control and groups with different trauma severity,and the correlation between serum HBP concentration and trauma severity was analyzed by spearman correlation.Patients with multiple trauma were also divided into nonMODS group and MODS group according to whether MODS occurred or not,and the clinical data of the two groups were compared,including demographic data(age,gender,body mass index),trauma-related conditions(direct injury site,injury admission time,ISS score,GCS score,temperature,pulse,respiration,mean arterial pressure at admission),clinical treatment(ventilator use,blood product transfusion,vasopressor use,surgery,Body fluid culture)and 28 d survival,as well as the laboratory indicators within 24 hours of admission: HBP,procalcitonin(PCT),leukocytes(WBC),neutrophils(NEUT),red blood cells(RBC),hemoglobin(Hb),platelets(Plt),glutamate aminotransferase(ALT),alanine aminotransferase(AST),albumin(ALB),urea(Urea),creatinine(Scr),activated partial thromboplastin time(APTT),Prothrombin time(PT),thrombin time(TT),fibrinogen(FIB),D-dimer(D-D).The statistically significant indexes of univariate analysis were included in the binary logistic regression to analyze the independent risk factors of MODS after multiple trauma,and the ROC curves were drawn to analyze the diagnostic value of serum HBP for MODS after multiple trauma.In addition,according to the 28 d survival of MODS patients after multiple trauma,they were divided into good prognosis group and poor prognosis group.By comparing the serum HBP concentration of the two groups and drawing ROC curve to analyze the diagnostic value of serum HBP concentration for the prognosis of MODS patients after multiple trauma.Results:1.The healthy control group,minor trauma group,serious trauma group and severe trauma group were comparable in terms of gender,age and body mass index. Compared with the healthy control group,the serum HBP levels of patients in the minor,serious and severe trauma groups all increased in the early post trauma period,and were positively correlated with the severity of multiple trauma.2.Compared with the non-MODS group after multiple trauma,most of patients in the MODS group were older,had higher ISS scores,had craniocerebral injury as the direct injury site,had faster breathing rates and pulse on admission,had more surgical rates and supportive treatment,had higher level of laboratory indicators such as HBP,WBC,NEUT,D-D,ALB,RBC and had lower Hb,and had a poor prognosis.The differences were statistically significant.There were no significant differences in gender,body mass index,past medical history,smoking and drinking history,MAP,and the laboratory indicators included PCT,PLT,ALT,AST,UREA,SCR,APTT,TT,FIB and so on.3.Binary logistic analysis showed that HBP(OR=1.489,95%CI:1.172～1.891,p=0.001)and SOFA score(OR=3.684,95%CI:1.625～8.351,p=0.002)were independent risk factors for MODS after multiple trauma.The AUC value of serum HBP for evaluating the MODS efficacy after trauma was 0.938(95% CI:0.8935～0.9825),the optimal cut-off value was 23.28 ug/L,the specificity was 79.66%,and the sensitivity was 97.37%.The AUC value of the SOFA score for evaluating the MODS efficacy after trauma was 0.905(95% CI: 0.8445～0.9655), the optimal cut-off value was 2.5,the specificity was 86.44%,and the sensitivity was 84.21%.4.Comparing with the good prognosis group,the serum HBP levels were higher in the poor prognosis group of MODS after multiple trauma.The AUC value of serum HBP level for the evaluation of MODS after multiple trauma was 0.872(95% CI: 0.7826～0.9613),the optimal cut-off value was 34.89ug/L,the specificity was 77.27%,and the sensitivity was 93.33%.Conclusion:The concentration of serum HBP in patients with multiple trauma increased early after trauma,and was associated with the severity of multiple trauma.Serum HBP is an independent risk factor for MODS after multiple trauma,which has a predictive and prognostic value for MODS after multiple trauma.Inhibiting the release of excessive HBP might become a new target for the treatment after multiple trauma.