AlRawahi et al. concluded that sepsis and multiple organ failure (MOF) are the predominant cause of late death in severe multiple trauma (MT) [1]. They suggested that repeated measures of procalcitonin (PCT) during disease course may allow for early recognition of septic complications and detection of multiple organ failure (MOF), resulting in earlier therapeutic decisions and an impact on survival and improve outcomes [1]. We would like to make some comments. A recent meta-analysis evaluating more than 26,000 MT patients revealed a pooled incidence of acute kidney injury (AKI) in MT of more than 20% [2]. In addition, in a further breakdown of the A KI stages, over 40% of these patients were classified with more severe forms of AKI (RIFLE I or F or stages 2–3) [2] suggesting a probable use of renal replacement therapy (RRT) between 5 and 10% [2]. This incidence could be even higher (up to 20%) if MT is complicated by sepsis and MOF [3]. If we apply the same trends for the study of AlRawahi et al., the incidence of RRT in MT with sepsis and MOF could have an impact upon the reliability of the PCT level under those conditions. PCT has an approximate molecular weight of 14.5 kDa [4]. The contemporary continuous RRT (CRRT) membranes are able to remove molecules as large as 35 kDa [4]. Hence, most of the PCT mass will be eliminated by convective flow [4], but adsorption also contributes to the elimination if using new highly adsorptive membranes (HAM) [5]. Accordingly, an imbalance between the use of CRRT in the two cohorts (MT alone or MT with sepsis and MOF) will have an important impact upon the values of PCT in each cohort but more so in

中文翻译：

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降钙素原可用于早期发现严重多发性创伤中的败血症和多器官衰竭：谨防一些混杂因素

阿尔拉瓦希等人。得出的结论是，败血症和多器官衰竭 (MOF) 是严重多发性创伤 (MT) 晚期死亡的主要原因 [1]。他们建议，在病程中重复测量降钙素原 (PCT) 可能有助于早期识别脓毒症并发症和检测多器官衰竭 (MOF)，从而做出更早的治疗决策并影响生存并改善结果 [1]。我们想发表一些意见。最近对超过 26,000 名 MT 患者进行的一项荟萃​​分析显示，MT 中急性肾损伤 (AKI) 的合并发生率超过 20% [2]。此外，在 A KI 分期的进一步细分中，超过 40% 的这些患者被归类为更严重的 AKI 形式（RIFLE I 或 F 或 2-3 期）[2]，表明可能使用肾脏替代疗法（ RRT）介于 5% 和 10% [2] 之间。如果 MT 并发败血症和 MOF，这种发生率可能会更高（高达 20%）[3]。如果我们将相同的趋势应用于 AlRawahi 等人的研究，则在这些条件下，患有败血症和 MOF 的 MT 中 RRT 的发生率可能会对 PCT 水平的可靠性产生影响。PCT 的分子量约为 14.5 kDa [4]。现代连续 RRT (CRRT) 膜能够去除大至 35 kDa 的分子 [4]。因此，大部分 PCT 质量将通过对流消除 [4]，但如果使用新的高吸附膜 (HAM)，吸附也有助于消除[5]。因此，两个队列（单独的 MT 或 MT 伴脓毒症和 MOF）使用 CRRT 之间的不平衡将对每个队列中的 PCT 值产生重要影响，但在