1
|
Shang W, Cao Y, Li Y, Ma M, Che H, Xiao P, Yu Y, Kang H, Wang D. Effect of early hemostasis strategy on secondary post-traumatic sepsis in trauma hemorrhagic patients. Injury 2024; 55:111205. [PMID: 38006781 DOI: 10.1016/j.injury.2023.111205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/02/2023] [Accepted: 11/12/2023] [Indexed: 11/27/2023]
Abstract
INTRODUCTION Fibrinogen and platelet, as the two main components of hemostatic resuscitation, are frequently administered in traumatic massive hemorrhage patients. It is reasonable to infer that they may have an impact on post-traumatic sepsis as more and more recognition of their roles in inflammation and immunity. This study aims to determine the association between the fibrinogen/platelet transfusion ratio during the first 24 h after trauma and the risk of the post- traumatic sepsis. METHODS We analyzed the data from the National Trauma Data Bank (NTDB). Subjects included the critically injured adult patients admitted to Level I/II trauma center from 2013 to 2017 who received fibrinogen and platelet supplementation and more than 10 units (about 4000 ml) packed red blood cells (pRBCs) during the first 24 h after trauma. Two parts of analyses were performed: (1) multivariable stepwise regression was used to determine the variables that influence the risk of post-traumatic sepsis; (2) propensity score matching (PSM), to compare the influences of different transfusion ratio between fibrinogen and platelet on the risk of sepsis and other outcomes after trauma. RESULTS 8 features were screened out by bi-directional multivariable stepwise logistic regression to predict the post-traumatic sepsis. They are age, sex, BMI, ISSabdomen, current smoker, COPD, Fib4h/24h and Fib/PLT24h. Fib/PLT24h was negatively related to sepsis (p < 0.05). A total of 1601 patients were included in the PSM cohort and grouped by Fib/PLT24h = 0.025 according to the fitting generalized additive model (GAM) model curve. The incidence of sepsis was significantly decreased in the high Fib/PLT group [3.3 % vs 9.4 %, OR = 0.33, 95 %CI (0.17-0.60)]; the length of stay in ICU and mechanical ventilation were both shortened as well [8 (IQR 2.00,17.00) vs 9 (IQR 3.00,19.25), p = 0.006 and 4 (IQR 2.00,10.00) vs 5 (IQR 2.00,14.00), p = 0.003, respectively. CONCLUSIONS Early and sufficient supplementation of fibrinogen was a convenient way contribute to reduce the risk of sepsis after trauma.
Collapse
Affiliation(s)
- Wei Shang
- Medical School of Chinese PLA, Beijing, China; Department of Blood Transfusion Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yuan Cao
- Emergency Department, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yun Li
- Medical School of Chinese PLA, Beijing, China; Department of Critical Care Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Mingzi Ma
- Department of Blood Transfusion, Shenyang Women's and Children's Hospital, Shenyang, China
| | - Hebin Che
- Medical Big Data Research Center, Chinese PLA General Hospital, Beijing, China
| | - Pan Xiao
- Department of Blood Transfusion Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing, China; Department of Blood Transfusion, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yang Yu
- Medical School of Chinese PLA, Beijing, China; Department of Blood Transfusion Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Hongjun Kang
- Medical School of Chinese PLA, Beijing, China; Department of Critical Care Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Deqing Wang
- Medical School of Chinese PLA, Beijing, China; Department of Blood Transfusion Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.
| |
Collapse
|
2
|
Sordi R, Bojko L, Oliveira FRMB, Rosales TO, Souza CF, Moreno LW, Ferreira Alves G, Vellosa JCR, Fernandes D, Gomes JR. Doxycycline reduces liver and kidney injuries in a rat hemorrhagic shock model. Intensive Care Med Exp 2024; 12:2. [PMID: 38194181 PMCID: PMC10776514 DOI: 10.1186/s40635-023-00586-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/18/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Hemorrhagic shock (HS), which causes insufficient tissue perfusion, can result in multiple organ failure (MOF) and death. This study aimed to evaluate whether doxycycline (DOX) protects cardiovascular, kidney, and liver tissue from damage in a rat model of HS. Immediately before the resuscitation, DOX (10 mg/kg; i.v.) was administered, and its protective effects were assessed 24 h later. Mean arterial pressure, renal blood flow, heart rate, vasoactive drug response, and blood markers such as urea, creatinine, AST, ALT, CPK, CPR, and NOx levels were determined. RESULTS We showed that DOX has a significant effect on renal blood flow and on urea, creatinine, AST, ALT, CPK, and NOx. Morphologically, DOX reduced the inflammatory process in the liver tissue. CONCLUSIONS We conclude that DOX protects the liver and kidney against injury and dysfunction in a HS model and could be a strategy to reduce organ damage associated with ischemia-and-reperfusion injury.
Collapse
Affiliation(s)
- Regina Sordi
- Department of Pharmacology, Graduate Program in Pharmacology, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
- Department of Structural Biology, Molecular and Genetics, Post Graduation Program in Biomedical Science, Universidade Estadual de Ponta Grossa, Avenida Carlos Cavalcanti, 4748, Ponta Grossa, PR, 84030-900, Brazil
| | - Luana Bojko
- Department of Structural Biology, Molecular and Genetics, Universidade Estadual de Ponta Grossa, Ponta Grossa, PR, Brazil
| | - Filipe R M B Oliveira
- Department of Pharmacology, Graduate Program in Pharmacology, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Thiele Osvaldt Rosales
- Department of Pharmacology, Graduate Program in Pharmacology, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Camila Fernandes Souza
- Department of Pharmacology, Graduate Program in Pharmacology, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Lucas Wenceslau Moreno
- Department of Structural Biology, Molecular and Genetics, Universidade Estadual de Ponta Grossa, Ponta Grossa, PR, Brazil
| | - Gustavo Ferreira Alves
- Department of Pharmacology, Graduate Program in Pharmacology, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - José Carlos Rebuglio Vellosa
- Department of Clinical and Toxicological Analysis, Universidade Estadual de Ponta Grossa, Ponta Grossa, PR, Brazil
| | - Daniel Fernandes
- Department of Pharmacology, Graduate Program in Pharmacology, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Jose Rosa Gomes
- Department of Structural Biology, Molecular and Genetics, Post Graduation Program in Biomedical Science, Universidade Estadual de Ponta Grossa, Avenida Carlos Cavalcanti, 4748, Ponta Grossa, PR, 84030-900, Brazil.
| |
Collapse
|
3
|
Dai C, Lin X, Qi Y, Wang Y, Lv Z, Zhao F, Deng Z, Feng X, Zhang T, Pu X. Vitamin D3 improved hypoxia-induced lung injury by inhibiting the complement and coagulation cascade and autophagy pathway. BMC Pulm Med 2024; 24:9. [PMID: 38166725 PMCID: PMC10759436 DOI: 10.1186/s12890-023-02784-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 11/23/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Pulmonary metabolic dysfunction can cause lung tissue injury. There is still no ideal drug to protect against hypoxia-induced lung injury, therefore, the development of new drugs to prevent and treat hypoxia-induced lung injury is urgently needed. We aimed to explore the ameliorative effects and molecular mechanisms of vitamin D3 (VD3) on hypoxia-induced lung tissue injury. METHODS Sprague-Dawley (SD) rats were randomly divided into three groups: normoxia, hypoxia, and hypoxia + VD3. The rat model of hypoxia was established by placing the rats in a hypobaric chamber. The degree of lung injury was determined using hematoxylin and eosin (H&E) staining, lung water content, and lung permeability index. Transcriptome data were subjected to differential gene expression and pathway analyses. In vitro, type II alveolar epithelial cells were co-cultured with hepatocytes and then exposed to hypoxic conditions for 24 h. For VD3 treatment, the cells were treated with low and high concentrations of VD3. RESULTS Transcriptome and KEGG analyses revealed that VD3 affects the complement and coagulation cascade pathways in hypoxia-induced rats, and the genes enriched in this pathway were Fgb/Fga/LOC100910418. Hypoxia can cause increases in lung edema, inflammation, and lung permeability disruption, which are attenuated by VD3 treatment. VD3 weakened the complement and coagulation cascade in the lung and liver of hypoxia-induced rats, characterized by lower expression of fibrinogen alpha chain (Fga), fibrinogen beta chain (Fgb), protease-activated receptor 1 (PAR1), protease-activated receptor 3 (PAR3), protease-activated receptor 4 (PAR4), complement (C) 3, C3a, and C5. In addition, VD3 improved hypoxic-induced type II alveolar epithelial cell damage and inflammation by inhibiting the complement and coagulation cascades. Furthermore, VD3 inhibited hypoxia-induced autophagy in vivo and in vitro, which was abolished by the mitophagy inducer, carbonyl cyanide-m-chlorophenylhydrazone (CCCP). CONCLUSION VD3 alleviated hypoxia-induced pulmonary edema by inhibiting the complement and coagulation cascades and autophagy pathways.
Collapse
Affiliation(s)
- Chongyang Dai
- Qinghai University, Xining, Qinghai Province, 810016, People's Republic of China
| | - Xue Lin
- West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610000, People's Republic of China
| | - Yinglian Qi
- Qinghai Normal University, Xining, Qinghai Province, 810008, People's Republic of China
| | - Yaxuan Wang
- Qinghai University, Xining, Qinghai Province, 810016, People's Republic of China
| | - Zhongkui Lv
- Qinghai University, Xining, Qinghai Province, 810016, People's Republic of China
| | - Fubang Zhao
- Qinghai University, Xining, Qinghai Province, 810016, People's Republic of China
| | - Zhangchang Deng
- Qinghai University, Xining, Qinghai Province, 810016, People's Republic of China
| | - Xiaokai Feng
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China.
- Department of Respiratory and Critical Care Medicine, Qinghai Provincial People's Hospital, Qinghai University, Xining, Qinghai Province, 810007, People's Republic of China.
| | - Tongzuo Zhang
- Northwest Institute of Plateau Biology, Chinese Academy of Sciences, Xining, Qinghai Province, 810001, People's Republic of China.
| | - Xiaoyan Pu
- Qinghai University, Xining, Qinghai Province, 810016, People's Republic of China.
| |
Collapse
|