A Preliminary Clinical Research About Diagnostic And Prognostic Indicators Of Burn And Trauma Related ALI/ARDS Disease

BackgroundExternal causes of injury and poisoning especially burn and trauma are the top five fatal disease among urban and rural residents.Recently casualties in severe natural disasters?public emergencies and production safety accidents were mainly burn and trauma ones.How to treat these diseases better,and reduce the mortality and morbidity has always been the difficult problems that need to figure out.Since multiple organ dysfunction syndrome is one of the leading causes of death in burn and trauma patients,the research and application on MODS's early diagnostic indicators and prognostic indicators will help to improve the diagnostic and treatment efficiency.Among all organs,ALI/ARDS is the earliest?highly morbidity organ injury,and more tend to influence others.However,the relevant epidemiological researches about ALI/ARDS were mainly made by develop countries in Europe and North America,but rarely in our country.The diagnosis on ALI/ARDS mainly depends on the primary causes?clinical symptoms?arterial blood gas analysis and imaging findings,because there are lack of early diagnostic indicators and prognostic indicators.In 2013,sCD74,the soluble form of MIF's receptor CD74 got the new progress reports and caught our attention.First of all,MIF cooperated with CD74 were confirmed to participate in regulating the accumulation of inflammatory cells and the release of inflammatory factors such as TNF-? and IL-8 during ALI/ARDS.Since the further research found that the content of MIF was not completely positive correlated with susceptibility and severity of lung injury,which suggested that there might exist other factors influencing the development and progression of ALI/ARDS alone or cooperated with MIF and CD74.Furthermore,previous study reported that soluble form of membrane molecular played important roles on diagnosis,pathogenesis and treatment of related disease.Thus,we propose to collect the clinical databases of burn and trauma patients who are diagnosed with ALI/ARDS,as well as detecting the content of MIF and s CD74 in serum of peripheral blood,in order to find the relationship between sCD74?MIF and ALI/ARDS by comparing with clinical index presently,and definite whether sCD74 is expected to be the diagnosis and prognosis indicator of burn and trauma related ALI/ARDS.Part 1.The epidemiological analysis of burn and trauma related ALI/ARDS patients in Shanghai XX comprehensive Hospital from 2013 to 2015 and a preliminary study on ALI/ARDS's prognostic indicatorsObjective:In order to analysis the epidemiological characteristics of burn and trauma related ALI/ARDS patients in Shanghai XX comprehensive Hospital from 2013 to 2015,as well as preliminary discuss the prognostic indicators of burn and trauma related ALI/ARDS.Methods:It's a prospective single-center clinical investigation study.We collect the demographic data?basic diseases?etiology?treatment and prognosis outcomes of burn and trauma related ALI/ARDS patients,evaluate the APACHE II score?SOFA score within 24 h,for statistical analysis.Group by primary causes,we analysis the difference of general information?state of illness?treat methods and outcomes between burn and trauma patients.Otherwise,we preliminary discuss the prognostic indicators of burn and trauma related ALI/ARDS by setting treatment outcome(alive/dead)as dependent variable.Results:There are 81 burn and trauma related ALI/ARDS patients participating in our study from 01-01-2013 to 12-31-2015,age(48.02±16.05)years,mostly are males(54.3%),burn is the mainly primary cause(56.8%),inhalation injury is the leading cause of lung injury(56.8%),the APHACHE? score within 24 h is(13.90±6.87),well the SOFA score is(7.00±3.77),the AUC of APHACHE? and SOFA in evaluating the prognosis of burn and trauma related ALI/ARDS patients are 0.789 and 0.793,respectively,P=0.001?0.001.63.0 percent patients in hospital need mechanical ventilation,and at least a half ones need 6 or more days' assisted respiration.In addition,the 28 days survival rate of burn and trauma related ALI/ARDS patients is high(88.9%),LOS is(39.64 + 29.31)days,more than half of the ICU patients stay in hospital longer than 3 weeks.For different primary causes,the state of ARDS illness?breathing machine usage or not?breathing machine days and treatment outcomes are different,P = 0.019?< 0.001?< 0.001 and 0.003.Conclusions:This part describe the general information of burn and trauma related ALI/ARDS patients in our unit.Among these,we found inhalation injury patients get a higher proportion,adult males are more easily to be victims.And ALI/ARDS patients caused by burn tend to be more severity in ARDS ? more frequently and longer mechanical ventilation use and unfortunately,worse outcomes.On the treatment aspect,ALI/ARDS patients need mechanical ventilation mostly and longer than 6 days,LOS is also very long,which will increase the medical expenses and enhance the economic burden.As prognostic indicators,APHACHE? ?SOFA are possible to be prognostic indicators of ALI/ARDS.The results above just come from preliminary exploration,it is necessary to process large sample research in the future.Part 2.A preliminary clinical research about sCD74 and MIF as diagnosis indicators of burn and trauma related ALI/ARDSObjective:Compared with TNF-?and IL-6 in serum,we purpose to explore if sCD74 and MIF could be the diagnosis indicators of burn and trauma related ALI/ARDS preliminary.Methods:It is a case-control study,the case group includes 28 burn and trauma related ALI/ARDS patients,the control group A includes 17 healthy adult volunteers,and the control group B includes 17 healthy adult volunteers?6 burn patients and 8 trauma patients that without ALI/ARDS.We compare the differences between the case group and control group A of sCD74?TNF-??IL-6 and MIF in serum,and analysis the relationship between s CD74?TNF-??IL-6?MIF and ALI/ARDS diseases.Furthermore,we explore if sCD74 and MIF in serum could be able to become the diagnosis indicators of burn and trauma related ALI/ARDS.Results : There exists significant statistical significances between case group and control group A about sCD74?TNF-??IL-6 and MIF in serum,P= <0.001?<0.001?<0.001 and 0.004.Logistic regression analysis suggests that sCD74?TNF-?and MIF have influence on diagnosis of burn and trauma related ALI/ARDS by single factor analysis(P= 0.001?0.001 and 0.042,OR=0.959?0.950 and 0.974),while just sCD74 alone has influence on diagnosis of burn and trauma related ALI/ARDS by multiple factor analysis(P= 0.007,OR=0.957).We use ROC curve to evaluate if sCD74?TNF-?and MIF could become diagnosis indicators of burn and trauma related ALI/ARDS,and the AUC is 0.838?0.736 and 0.651,respectively(P= 0.001?0.002 and 0.046).Conclusions:Similar to TNF-? and IL-6,the contents of sCD74 and MIF in peripheral blood serum of burn and trauma related ALI/ARDS patients are significantly higher than normal persons,suggesting that sCD74 and MIF are possible to become the diagnosis indicators of burn and trauma related ALI/ARDS.Furthermore,sCD74 has severely influence on diagnosis of burn and trauma related ALI/ARDS.Meanwhile,sCD74 has better diagnostic value on burn and trauma related ALI/ARDS than TNF-? and MIF.We propose that sCD74 is expected to become an earlier diagnosis indicator on burn and trauma related ALI/ARDS.