Clinical Study On Post-traumatic ALI/ARDS Risk Factors With The Role Of WBC, HB, IL-6, PCT, CRP, PT, APTT,D-dimer, ALT, AST In Predicting Of ALI/ARDS

Background:A number of traditional risk factors has been recognized to be associated with develop of acute lung injury ALI/ARDS. However, these studies have included common multiple injury patients.Objectives:The goal of our prospective observational study to evaluate the following objectives:to document the development of ALI/ARDS in multiple injury patients by using the American-European conference (AECC) definitions; to document the incidence rate of ALI/ARDS development in the TICU; and to document the relationship between antecedent traditional risk conditions influencing clinical prognosis in stratified patients admission to the TICU, and early recognize with diagnosis of ALI/ARDS.Methods:In this prospective clinical study, seriously injured multiple-injury patients from intensive Care Unit (TICU) in Trauma Center of the Tong Ji Hospital of Huazhong University of Science and Technology in Wuhan of China were studied. Potential risk factors include Age, Gender, ISS, GCS, P.R.C, Plasma, Platelet, Lung contusion., SIRS, DIC, SBP, Liver dysfunction, Renal impairment, Shock and traumatic pancreatitis et al affecting the development of ALI/ARDS were analyzed by the classification of variable using Chi-square test or Fisher’s exact probability method to analyze; continuous variable, like PaO2/fIO2in72hours.Results:It is no statistically significant difference of gender in two groups (P>0.05), but age is different, when age is>60years old, the proportion of ALI/ARDS group is larger than NON-ALI/ARDS group. In these two groups, the difference of Platelet has not statistical significance (P>0.05). But ISS, GCS, P.R.C, Plasma, Lung contusion., SIRS, DIC, Liver dysfunction,Renal impairment, Shock and traumatic pancreatitis have statistical significance (all P<0.05). When ISS>28, the rate of ALI/ARDS group is larger than NON-ALI/ARDS group. In ARDS group, the value of GCS is smaller. The rate of yes of P.R.C, Plasma, Lung contusion, SIR, DIC, acute liver injury, Renal impairment, shock. Traumatic pancreatitis in ALI/ARDS group are largest than Non ARDS group. There are statistical significant difference of SBP and APACHEII; their means are larger in ALI/ARDS group than NON-ALI/ARDS groupConclusions:age older than65years patients with packed blood cell and Plasma transfusions in the early phase flowing multiple trauma were found to be a risk factors may contribute to ALI/ARDS develop. The other studied factors, including Lung contusion, APACHE II score over20, ISS over16, DIC, SIRS, Shock and SBP may predict the harmful prognosis of ALI/ARDS in the early phase of trauma with their effects attenuating in the later phase. Liver dysfunction, traumatic pancreatitis, Renal function impairment may also suggest poor prognosis during the entire management period. BACK GROUND:Trauma very common complicated by acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) and have better outcome and a lower mortality than ALI/ARDS induce by other causes.OBJECTIVE:To identify serum potential inflammatory biomarker and coagulopathy markers to improve the understanding of the complex interaction between the inflammatory, coagulation biomarkers involved and evaluate them as possible prognostic indicators for the development of patients with ALI/ARDS also tested the relation of serum levels of hemoglobin, alanine aminotransferase, aspartate transaminase basis in early post-traumatic ALI/ARDS.METHOD:In this prospective cohort study, severely injured multiple-trauma patients from intensive Care Unit (TICU) in Trauma Center of the Tong Ji Hospital of Huazhong University of Science and Technology in Wuhan of China were studied. The Wilcoxon’s sign rank Test was used to analyze the difference of the change of laboratory index (WBC, HB, IL-6, PCT, CRP, PT, APTT, D-dimer, ALT, AST) in24hours and in72hours. And the independent sample T-test was used to analyze the difference of laboratory index in two groups. Using Analysis of variance of repeated measures to analyze the change for24hours and72hours of laboratory indexes of two groups.RESLUT:The difference of WBC, HB, PCT, IL-6, ALT and AST in24hours and72hours have statistical significant (P<0.05) within groups. In time groups, the APTT and CRP have statistical significant difference in NON-ALI/ARDS group and ALI/ARDS group (all P<0.05). The WBC、HB、PT、D-DIMER、IL-6、PCT、ALT and AST have not statistical significant difference in Non ARDS group and ARDS group (all P>0.05) at24hours. The difference of WBC, HB, PT, I-L6, ALT and AST in24hours and72hours have statistical significant (P<0.05). The time interacting with the group have statistical significance in PT (P<0.05), means The change of the two groups of PT is not the same in24hours and72hours.Conclusions:Accurate assessment, early prevent of trauma induce ALI/AR are important for the outcome of patients with ALI/ARDS caused by multiple trauma WBC. HB, IL-6, PCT, ALT, AST and PT are independent predictors of ALI/ARDS development in patients with multiple trauma patients.