Clinical Significance of Blood Ulinastatin Measurement in Trauma Patients

DOI 12 References
  • Inagaki Nobuhiro
    Department of Emergency Medicine, Tokyo Women's Medical University
  • Ishikawa Masatake
    Department of Emergency Medicine, Tokyo Women's Medical University
  • Soga Yukihiro
    Emergency and Critical Care Center, Tokyo Women's Medical University Medical Center East
  • Nakagawa Takao
    Emergency and Critical Care Center, Tokyo Women's Medical University Medical Center East
  • Suzuki Tadashi
    Department of Emergency Medicine, Tokyo Women's Medical University

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Other Title
  • 外傷患者における血中ウリナスタチン値測定の臨床的意義

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Abstract

It has been known that the production of ulinastatin (UTI) increases when the human body is damaged and that the degree of damage correlates well with urinary UTI level. UTI is considered to excrete from blood to urine. An earlier study reported that blood UTI level could serve as a sepsis severity in dicator because it is associated with thenumber of impaired organs in patients with sepsis. In this study, we measured blood UTI level in trauma patients over time to investigate the relationship with the severity of trauma and other inflammation parameters, thereby examining the utility of measuring blood UTI level in trauma patients. Seventeen trauma patients without any history, who did not receive any exogenous UTI for treatment, were the subjects for this study. They were divided into two groups by injury severity score (ISS) of 25 or higher or less than 25. Each group was further divided into two subgroups by improvement or deterioration of their sequential organ failure assessment (SOFA) score in 48 hours from admission, The results showed that six patients had ISS of 25 or higher and worse SOFA score (Group A), five patients had ISS of 25 or higher and improved SOFA score (Group B), and six patients had ISS of less than 25 and improved SOFA score (Group C). No patients had ISS of less than 25 and worse SOFA score. The mortality rates of groups A, B, and C were 33%, 0%, and 0%. Blood UTI level was measured on admission and 1st, 3rd, 5th and 7th hospital day to examine its change in each group. None of the groups showed any significant differences in blood UTI by ISS on admission. UTI was not associated with anatomical severity when they suffered from trauma. Blood UTI level tended to increase in the group with the SOFA score that deteriorated (Group A): it was significantly higher in Group A than in the other two groups with the improved SOFA score. It appeared that the subjects in Group A were in anatomically and physiologically severe conditions as well as continuously affected by the trauma. Blood UTI level was positively correlated with the SOFA score (R=0.493, p<0.0001), CRP (R=0.388, p=0.0013), and IL-6 (R=0.26, p=0.036). The change in blood URI level was well correlated with physiological severity. It is therefore suggested that the increased blood UTI level over time in trauma patients may serve as an indicator of the development of multiple organ failure after trauma, and that blood UTI level may vary in association with the severity of trauma, therapeutic effects, and outcome.

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