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Invited Critique
December 21, 2009

Possibility of Sepsis Prevention With Common GenotypeComment on “Clinical Relevance of the TLR4 11367 Polymorphism in Patients With Major Trauma”

Arch Surg. 2009;144(12):1149. doi:10.1001/archsurg.2009.221

Many surgeons have pondered the possibility of a common genotype or phenotype among patients with repeated instances of trauma. This elegant study by Duan et al uses laboratory findings (a genetic variant that may lower responses to noxious stimuli, resulting in less multiorgan dysfunction and sepsis) to look for associations in the clinical arena. They followed up 132 patients who had a mean estimated ISS of 25.5. Seventy-nine of the 132 patients (60%) developed sepsis. The authors conducted ex vivo tests using blood samples from each patient and recorded their overall clinical course. Their findings that the risk of sepsis was lower in patients carrying 1 or 2 C alleles (as opposed to being homozygous for the G allele) implies, potentially, a lower mortality rate in this group. Their study was likely too small to evaluate short- or long-term mortality, however. One could postulate that the patients with lower risk of sepsis and multiorgan dysfunction were less likely to die or have prolonged hospitalization and, therefore, would have more opportunity for trauma recidivism. Hypotheses generations aside, their findings could be used as they suggest, to screen patients who sustain significant trauma for the likelihood of developing sepsis and MOD. Whether this could be then translated into a sepsis prevention strategy of more than increased awareness of the potential has yet to be determined.

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