RT Journal Article
SR Electronic
T1 Early complementopathy predicts the outcomes of patients with trauma
JF Trauma Surgery & Acute Care Open
JO TSACO
FD BMJ Publishing Group Ltd
SP e000217
DO 10.1136/tsaco-2018-000217
VO 4
IS 1
A1 Yansong Li
A1 Qingwei Zhao
A1 Bin Liu
A1 Alexander Dixon
A1 Leopoldo Cancio
A1 Michael Dubick
A1 Jurandir Dalle Lucca
YR 2019
UL http://tsaco.bmj.com/content/4/1/e000217.abstract
AB Background Complementopathy (rapid complement activation and consumption after trauma) has been reported in trauma patients, but the underlying mechanism of these phenomena and their clinical significance remain unclear. This study aimed to determine the complement/complement pathway activation and identify the association of complement activation with clinical outcomes in trauma patients.Methods We studied 33 trauma patients with mean Injury Severity Score of 25, and 25 healthy volunteers. Sera were collected on patients’ arrival at the emergency department, as well as 1, 2, 3, 5, and 7 days after trauma, to measure the levels of terminal complement activation product soluble C5b-9 (sC5b-9) by ELISA. In addition, the functional complement activation pathway was evaluated using a commercial complement system screening kit.Results Serum concentrations of sC5b-9 (complement terminal pathway activity) were significantly increased in trauma patients throughout the entire observation period except on day 1. Complement terminal activities were significantly higher in 27 of 33 patients with systemic inflammatory response syndrome (SIRS) than non-SIRS patients on day 2, day 5, and day 7. Increased serum levels of sC5b-9 positively correlated with SIRS. Functional complement analysis revealed that the classical pathway was the predominant pathway responsible for complement activation. Burn patients tended to have a greater and prolonged classical pathway activation than non-burn patients, and burn injury and blunt injury were associated with higher blood levels of sC5b-9 than penetrating injury.Discussion Early complement activation through the classical pathway after trauma is observed and positively correlated with the development of SIRS. Thus, monitoring of the complement system might be beneficial in the care of critically injured patients.Level of evidence III.Study type Prognostic.