The Dynamic Changes And Meanings Of Activated Protein C And Thrombomodulin In Severe Multiple Trauma Patients

Objectives To detect the contents of Activated protein C (APC) and thrombomodulin(TM) in the different time after injury of the severe multiple trauma patients,and to observe the relationship between the dynamic changing rules and the prognosis of the severe multiple trauma patients.Methods Forty-nine patients multiple injured patients (Injury Severity Score, ISS≥16) were divided into coagulopathy group and non-coagulopathy group,multiple organ dysfunction syndrome (MODS)group and non-MODS group according to the coagulopathy and MODS diagnostic criteria. Plasma samples were collected after admission,1 and 2 days after injury,and then the plasma levels of APC and TM were measured by double-antibody sandwich enzyme-linked immunosorbent assay (ELISA).Logistic regression analysis was used to evaluate predictive values of plasma levels of APC and TM for MODS after injury. Receiver operating characteristic (ROC)curve was used to infer the relationship between plasma APC,TM level and prevalence of MODS.Result 1. The the lactate in artery blood,plasma levels of APC and TM on admission in the coagulopathy group were higher than those in non-coagulopathy group (P<0.05). The the lactate in artery blood,plasma levels of APC and TM were positively correlated with each other(P<0.01).2. The APACHEⅡscore and the rate of MODS in the coagulopathy group were higher than those in non-coagulopathy group (P<0.05). 3. The plasma levels of APC and TM on admission in the MODS group were higher than those in non-MODS group (P<0.05). The plasma levels of APC and TM on the second day in the MODS group were lower than those in non-MODS group (P<0.05).In the MODS group, the plasma levels of APC and TM on the first,second day were lower than those on admission (P<0.05); From admission to the first day after admission , the plasma levels of APC and TM in the MODS group decreased more than those in non-MODS group (P<0.05). 4. The ISS score,APACHEⅡscore,lactate in artery blood,plasma levels of APC and TM on admission in the MODS group were higher than those in non-MODS group (P<0.05); Logistic regression analysis showed that, plasma levels of APC in patients at admission (OR=1.054,95% CI 1.009-1.101;P=0.002),and APACHEⅡscore (OR =1.129,95%CI 1.001-1.516;P=0.038) were predictors of MODS after injury in severe multiple trauma patients. 5. A receiver operating characteristic curve identified the cutoff levels of plasma APC( 99.5%)predicting MODS of severe multiple trauma patients with the high sensitivity(81.3%)and specificity values(63.6%). And the areas under curve(AUC)of plasma APC levelwas the largest one(AUC=0.789).Conclusions Acute coagulopathy of trauma is associated with activation of protein C system induced by tuisse hypoperfusion;and the depletion of actived protein C and TM may play a role in the development of MODS after multiple trauma. The plasma levels of APC and TM can be used to assess the severity of illness and prognosis following major trauma. It offered us the reference of clinical treatment of severe multiple trauma.