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Martinez T, Harrois A, Codorniu A, Mongardon N, Pissot M, Popoff B, Leone M, Delhaye N, Vicaut E, Mathais Q, Legros V, Hanouz JL, Gatulle N, Ramonda V, Cohen B, Boutonnet M, Pottecher J, Libert N. Evaluation of severe rhabdomyolysis on day 30 mortality in trauma patients admitted to intensive care: a propensity score analysis of the Traumabase registry. Crit Care 2024; 28:382. [PMID: 39578880 PMCID: PMC11585242 DOI: 10.1186/s13054-024-05158-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Accepted: 11/03/2024] [Indexed: 11/24/2024] Open
Abstract
BACKGROUND Traumatic rhabdomyolysis (RM) is common and associated with the development of acute kidney injury and potentially with other organ dysfunctions. Thus, RM may increase the risk of death. The primary objective was to assess the effect of severe RM (Creatine Kinase [CK] > 5000 U/L) on 30-day mortality in trauma patients using a causal inference approach. METHODS In this multicenter cohort study conducted in France using a national major trauma registry (Traumabase) between January 1, 2012, and July 1, 2023, all patients admitted to a participating major trauma center hospitalized in intensive care unit (ICU) and with CK measurement were included. Confounding variables for both 30-day mortality and exposure were used to establish a propensity score. A doubly robust approach with inverse treatment weighting enabled the calculation of the average treatment effect on the treated (ATT). Analyses were performed in the overall cohort as well as in two subgroups: hemorrhagic shock subgroup (HS) and traumatic brain injury subgroup (TBI). Sensitivity analyses were conducted. RESULTS Among the 8592 patients included, 1544 (18.0%) had severe RM. They were predominantly males (78.6%) with median [IQR] age of 41 [27-58] years and severely injured (ISS 20 [13 - 29]) mainly from blunt trauma (90.8%). In the entire cohort, the ATT, expressed as a risk difference, was 0.073 [-0.054 to 0.200]. Considering the 1311 patients in the HS subgroup, the ATT was 0.039 [0.014 to 0.063]. As in the overall cohort, there was no effect on mortality in the TBI subgroup. Severe RM was associated with greater severity of trauma and more complications (whether related to renal function or not) during the ICU stay. Mortality due to multiorgan failure (39.9% vs 12.4%) or septic shock (2.6% vs 0.8%) was more frequent among patients with severe RM. CONCLUSIONS Severe RM was not associated with 30-day mortality considering the overall cohort. However, it was associated with a 4.0% increase in 30-day mortality among patients with concurrent hemorrhagic shock. Severe RM plays a significant role in ICU morbidity.
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Affiliation(s)
- Thibault Martinez
- Department of Anesthesiology and Intensive Care Medicine, Percy Military Training Hospital, 2 rue du Lieutenant Raoul Batany, 92140, Clamart, France
- UMRS 999, Équipe émergente DYNAMIC - Dysfonction d'organe et Microcirculation, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Anatole Harrois
- UMRS 999, Équipe émergente DYNAMIC - Dysfonction d'organe et Microcirculation, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Service d'Anesthésie-Réanimation Chirurgicale, Hôpital Bicêtre, Université Paris-Saclay, DMU 12, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Anaïs Codorniu
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Clichy, France
| | - Nicolas Mongardon
- Service d'anesthésie-Réanimation Et Médecine Péri-Opératoire, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Créteil, France
- Faculté de Santé, Université Paris Est Créteil, Créteil, France
- U955-IMRB, Equipe 03 ''Stratégies Pharmacologiques Et Thérapeutiques Expérimentales Des Insuffisances Cardiaques Et Coronaires'', Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Matthieu Pissot
- Department of Anesthesiology and Intensive Care Medicine, Percy Military Training Hospital, 2 rue du Lieutenant Raoul Batany, 92140, Clamart, France
| | - Benjamin Popoff
- Department of Anesthesiology, Critical Care and Perioperative Medicine, CHU Rouen, 76000, Rouen, France
| | - Marc Leone
- Department of Anesthesia and Critical Care Medicine, Hopital Nord, Marseille, France
| | - Nathalie Delhaye
- Department of Anesthesiology and Intensive Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Eric Vicaut
- Unité de Recherche Clinique, UMR 942, Université Paris 7, Hôpitaux Saint Louis Lariboisière, Assistance Publique - Hôpitaux de Paris, Paris, France
- Laboratoire d'Étude de La Microcirculation, UMR 942, Université Paris Cité, Paris, France
| | - Quentin Mathais
- Anaesthesiology and Intensive Care Department, Military Teaching Hospital Sainte Anne, Toulon, France
| | - Vincent Legros
- Anesthesiology, Critical Care and Perioperative Medicine, University Hospital of Reims - Université de Reims Champagne-Ardenne, VieFra, 51100, Reims, France
| | - Jean-Luc Hanouz
- Department of Anesthesiology and Critical Care Medicine, Caen University Hospital, Avenue de La Cote de Nacre, Caen, France
| | - Nicolas Gatulle
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Véronique Ramonda
- Anesthesiology, Critical Care and Perioperative Medicine, Hôpital Purpan, CHU de Toulouse, Toulouse, France
| | - Benjamin Cohen
- Department of Anesthesiology and Critical Care Medicine, CHU Tours, Tours University Hospital, Tours, France
| | - Mathieu Boutonnet
- Department of Anesthesiology and Intensive Care Medicine, Percy Military Training Hospital, 2 rue du Lieutenant Raoul Batany, 92140, Clamart, France
| | - Julien Pottecher
- Anesthesiology, Critical Care and Perioperative Medicine, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- ER3072, FMTS, Faculté de Médecine, Maïeutique Et Sciences de La Santé, Université de Strasbourg, Strasbourg, France
| | - Nicolas Libert
- Department of Anesthesiology and Intensive Care Medicine, Percy Military Training Hospital, 2 rue du Lieutenant Raoul Batany, 92140, Clamart, France.
- UMRS 999, Équipe émergente DYNAMIC - Dysfonction d'organe et Microcirculation, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
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Xie J, Ma Y, Huang Y, Wang Q, Xu Y, Zhang Q, Yang J, Yin W. Knockdown of SDC-1 Gene Alleviates the Metabolic Pathway for the Development of MODS. Mol Biotechnol 2024; 66:1961-1969. [PMID: 37515659 PMCID: PMC11281952 DOI: 10.1007/s12033-023-00809-9] [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: 04/25/2023] [Accepted: 06/26/2023] [Indexed: 07/31/2023]
Abstract
This study aims to reveal the metabolic differences between SDC-1 knockout mice and wild-type mice and the metabolic differences caused by shock in SDC-1 knockout mice by integrating transcriptomics and metabolomics. A total of 1009 differential metabolites were differentially expressed based on untargeted metabolomics and high-resolution mass spectrometry detection techniques. According to Kyoto Encyclopedia of Genes and Genomes enrichment, SDC-1 knockout significantly altered fat digestion and absorption, GnRH signaling pathway, fructose and mannose metabolism, and some other amino-related metabolic pathways and significantly modulated positively regulated longevity regulatory pathways, longevity regulatory pathways-worm, nicotinamide and niacinamide metabolism, and vitamin digestion and absorption pathways after its shock. Our findings indicate that SDC-1 knockout may have potential therapeutic effects in hemorrhagic shock by increasing nicotinamide metabolism.
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Affiliation(s)
- Jiangang Xie
- Department of Emergency, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China
| | - Yuexiang Ma
- Department of Emergency, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China
| | - Yang Huang
- Department of Emergency, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China
| | - Qianmei Wang
- Department of Emergency, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China
| | - Yunyun Xu
- Department of Emergency, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China
| | - Qi Zhang
- Department of Emergency, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China
| | - Jing Yang
- Department of Emergency, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China.
| | - Wen Yin
- Department of Emergency, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China.
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Prudovsky I, Kacer D, Lindner V, Rappold J, Carter DW. Tranexamic acid reduces inflammation, edema and burn wound conversion in a rodent model. Burns 2024; 50:947-956. [PMID: 38336496 PMCID: PMC11192045 DOI: 10.1016/j.burns.2024.01.024] [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: 05/04/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
Burn wound conversion is the observed process where superficial partial thickness burns convert into deep partial or full thickness burn injuries. This conversion process often involves surgical excision to achieve timely wound healing. Unfortunately, the pathophysiology of this phenomenon is multifactorial and poorly understood. Thus, a therapeutic intervention that may prevent secondary progression and cell death in burn-injured tissue is desirable. Recent work by our group and others has established that tranexamic acid (TXA) has significant anti-inflammatory properties in addition to its well-known anti-fibrinolytic effects. This study investigates TXA as a novel therapeutic treatment to mitigate burn wound conversion and reduce systemic inflammation. Sprague-Dawley rats were subjected to a hot comb burn contact injury. A subset of animals underwent a similar comb burn with an adjacent 30%TBSA contact injury. The interspaces represent the ischemic zones simulating the zone of stasis. The treatment group received injections of TXA (100 mg/kg) immediately after injury and once daily until euthanasia. Animals were harvested for analyses at 6 h and 7 days after injury. Full-thickness biopsies from the ischemic zones and lung tissue were assessed with established histological techniques. Plasma was collected for measurement of damage associated molecular patterns (DAMPs), and liver samples were used to study inflammatory cytokines expression. Treatment with TXA was associated with reduced burn wound conversion and decreased burn-induced systemic inflammatory response syndrome (SIRS). Lung inflammation and capillary leak were also significantly reduced in TXA treated animals. Future research will elucidate the underlying anti-inflammatory properties of TXA responsible for these findings.
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Affiliation(s)
- Igor Prudovsky
- Maine Health Institute for Research, 81 Research Drive, Scarborough, ME 04074, USA
| | - Doreen Kacer
- Maine Health Institute for Research, 81 Research Drive, Scarborough, ME 04074, USA
| | - Volkhard Lindner
- Maine Health Institute for Research, 81 Research Drive, Scarborough, ME 04074, USA
| | - Joseph Rappold
- Maine Health Institute for Research, 81 Research Drive, Scarborough, ME 04074, USA; Maine Medical Center, 22 Bramhall Street, Portland, ME 04105, USA
| | - Damien Wilson Carter
- Maine Health Institute for Research, 81 Research Drive, Scarborough, ME 04074, USA; Maine Medical Center, 22 Bramhall Street, Portland, ME 04105, USA.
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