Volume 10 Supplement 1

26th International Symposium on Intensive Care and Emergency Medicine

Open Access

Does recombinant factor VIIa change the inflammatory response to trauma? Preliminary results of inflammatory biomarkers in critically ill trauma patients

  • M Lissauer1,
  • S Johnson1,
  • T Scalea1,
  • R Dutton1,
  • P Maldeis2 and
  • R Moore2
Critical Care200610(Suppl 1):P171

https://doi.org/10.1186/cc4518

Published: 21 March 2006

Introduction

Recent advances have demonstrated a close association between coagulation and inflammation. The systemic inflammatory response syndrome (SIRS) is a common host response following trauma. Recombinant activated factor VII (rFVIIa) has been used to treat post-traumatic coagulopathy, but its impact on inflammation is unclear. The purpose of this study was to determine whether rFVIIa influences post-traumatic host inflammation.

Hypothesis

rFVIIa will increase the inflammatory response following trauma.

Methods

As part of an ongoing study to characterize the inflammatory response among critically ill trauma patients with SIRS, we identified four patients who received rFVIIa for treatment of traumatic coagulopathy. These patients were matched (TRISS, mechanism of injury, and age) with four SIRS patients who did not receive rFVIIa. Whole blood from both groups was analyzed for 78 inflammatory biomarkers by immunoassay. The average time from rFVIIa dose to sample was 36 hours. Data are expressed as the mean ± SD. Student's t test was used to determine significance between means of each group.

Results

Both groups were similarly matched for mechanism (blunt: 75% each group), TRISS (0.76 rFVIIa vs 0.74 control), and age (66 years rFVIIa vs 63 years control). rFVIIa patients had significantly lower levels of factor VII detected by immunoassay compared with control (127.8 ± 9 vs 283.5 ± 77.2 ng/ml, P < 0.04). The proinflammatory proteins that increased in the rFVIIa group are presented in Table 1. No other proinflammatory or any anti-inflammatory markers demonstrated significant differences between groups.

Table 1

Biomarker

Group 1 (rFVIIa)

Group 2 (control)

P value

TNF-α (pg/ml)

12 ± 4.2

5.6 ± 2.7

0.04

IL-8 (pg/ml)

48.63 ± 12.5

20.25 ± 6.99

0.01

MIP-1μ (pg/ml)

149.5 ± 19.8

97.0 ± 33.0

0.03

MDC (pg/ml)

339 ± 78

221 ± 32

0.03

MMP-2 (ng/ml)

639 ± 181

328 ± 174

0.05

CA-125 (U/ml)

14.21 ± 6.68

2.65 ± 1.22

0.01

Conclusion

Based on our preliminary results, rFVIIa induces a mild proinflammatory (TNF-α) state associated with neutrophil chemoattractants (IL-8, MIP-1β) and extracellular matrix breakdown (MMP-2, MDC). Lower factor VII levels in the treatment group may be secondary to clotting factor consumption following rFVIIa administration.

Authors’ Affiliations

(1)
R Adams Cowley Shock Trauma Center, University of Maryland Medical Center
(2)
BD Diagnostic Systems

Copyright

© BioMed Central Ltd 2006

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