Soluble selectin profiles associated with severe trauma
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Severe trauma acts as a trigger for the complex cascade of postinjury events leading to the re-lease of different mediators and the development of generalized inflammation. Selectins are a family of adhesion proteins that are responsible for the adherence of polymorphonuclear neu-trophils to the endothelium. This interaction plays an important role in the development of severe complications after multiple trauma. The aim of the present study is to follow the sequential altera-tions in circulating selectins level after severe injury and to evaluate the clinical significance of these mediators in monitoring prognosis and outcome. Thirty four severely traumatized patients were entered into the study. Serum sE-selectin, plasma sP-selectin and sL-selectin concentrations were me-asured and an APACHE II score was calculated on admission to the intensive care unit and during the subsequent 5 days. The patients were divided into survivors and nonsurvivors. Initial soluble P- and E-se-lectin concentrations were significantly elevated in all trauma patients. The highest values of these adhesion molecules were measured in all the observed days in patients with poor prognosis and outcome. In survivors we found a systematic decrease in the sP-selectin concentrations. On admission, the sL-selectin concentrations in all trauma patients were decreased. There were stable, very low values in non-survivors and a slow increase in circulating L-selectin in pa-tients who survived. The pattern of soluble selectins in patients with severe trauma is characterized by increased levels of P- and E-selectin and a decreased concentration of L-selectin. These findings suggest a widespread microvascular en-dothelial activation on injury in the early posttrau-matic period, which may be associated with in-creased neutrophil ? endothelial adhesion, neutrophil extravasation and migration. We sup-pose that these parameters of endothelial cell activation/injury may be useful as another early prognostic factor in severe trauma.
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A. Siemiatkowski, Department of Anesthesiology and Intensive Therapy, Medical Academy of Bialystok, M. Sklodowskiej-Curie 24a, 15-276 Bialystok, Poland