Diagnostic and prognostic significance of serum apoptosis markers in the patients with severe trauma injury

Introduction

The aim of the investigation was to analyze the diagnostic and prognostic significance of serum proapoptosis and antiapoptosis markers in the patients with severe trauma injury.

Methods

Thirty-three patients with severe trauma injury were enrolled into our investigation (we excluded patients with severe brain injury, the middle age was 39 ± 8, initial TRISS scale 7.8 ± 1.8, APACHE II 14 ± 5). All of the patients demonstrated signs of systemic inflammatory response, in 12 patients the infectious pulmonary complications were revealed and in 21 patients the infectious complications were not developed. Venous blood serum EDTA samples were investigated every day during a week in the -25°C freeze. We investigated antiapoptotic markers (soluble Fas-L, soluble APO-1/Fas, Cu/Zn superoxide dismutase), proapoptotic markers (protein p53, protein Bcl-2), and high-sensitivity CRP (ELISA, Bender Medsystem).

Results

We observed an increase in proapoptotic markers in patients with infectious complications from the first day in the ICU, antiapoptotic markers (Cu/Zn superoxide dismutase) were lower with regard to reference points. The patients demonstrated a maximum of Fas-L, protein p53, and protein Bcl-2 (near 50% relative to first day) on the second day. In patients without infection complications we identified a decreased level of proapoptotic markers and an increased level of antiapoptotic markers (SOD, soluble Fas-L, soluble APO-1/Fas). High-sensitivity CRP correlated with the severity of infectious complications.

Conclusions

Serum proapoptotic and antiapoptotic markers have demonstrated diagnostic and prognostic significance in the patients with severe trauma injury.