February 1985

Reprioritization of Hepatic Plasma Protein Release in Trauma and Sepsis

Author Affiliations

From the University of Maryland: Maryland Institute for Emergency Medical Services Systems (Drs Siegel, Coleman, Wiles, Belzberg, and Wedel, and Mr Placko) and the University of Maryland Cancer Center (Dr Brown), Baltimore; and the Centro di Studio per La Fisiopatologica dello Shock, Catholic University Rome (Dr Sganga). Dr Sganga is a CNR fellow.

Arch Surg. 1985;120(2):187-199. doi:10.1001/archsurg.1985.01390260051008

• We studied the temporal pattern of seven hepatic synthesized plasma proteins in 26 severely injured patients beginning in the immediate posttrauma period. Clinical sepsis developed in ten patients between three and eight days after injury, and 16 patients had nonseptic courses. In the initial five days after injury, except for albumin, all acute-phase protein levels rose. However, if sepsis developed, C-reactive protein, fibrinogen, ceruloplasmin, and α1-antitrypsin levels continued to be elevated after the initial five posttrauma days, while transferrin, albumin, and α2-macroglobulin levels fell. This differential response became more extreme as sepsis progressed. Covariance analysis of the regression of the five true acute-phase hepatic proteins on C-reactive protein showed that, when sepsis occurred after major traumatic injury, the C-reactive protein rise was associated with a significant reprioritization of hepatic acute-phase plasma protein release. This reprioritization response seems to be both a predictor of sepsis as well as a measure of the adequacy of the host response to trauma and sepsis.

(Arch Surg 1985;120:187-199)