BackgroundMajor trauma is associated with high incidence of septic complications and multiple organ dysfunction (MOD), which markedly influence the outcome of injured patients. Early identification of patients at risk of developing posttraumatic complications is crucial to provide early treatment and improve outcomes. We sought to evaluate the prognostic value of serum procalcitonin (PCT) levels after trauma as related to severity of injury, sepsis, organ dysfunction, and mortality.MethodsWe searched PubMed, MEDLINE, EMBASE, the Cochrane Database, and references of included articles. Two investigators independently identified eligible studies and extracted data. We included original studies that assessed the prognostic value of serum PCT levels in predicting severity of injury, sepsis, organ dysfunction, and mortality among critically injured adult patients.ResultsAmong 2015 citations, 19 studies (17 prospective; 2 retrospective) met inclusion criteria. Methodological quality of included studies was moderate. All studies showed a strong correlation between initial PCT levels and Injury Severity Score (ISS). Twelve out of 16 studies demonstrated significant elevation of initial PCT levels in patients who later developed sepsis after trauma. PCT level appeared a strong predictor of MOD in seven out of nine studies. While two studies did not show association between PCT levels and mortality, four studies demonstrated significant elevation of PCT levels in non-survivors versus survivors. One study reported that the PCT level of ≥ 5 ng/mL was associated with significantly increased mortality (OR 3.65; 95% CI 1.03–12.9; p = 0.04).ConclusionPCT appears promising as a surrogate biomarker for trauma. Initial peak PCT level may be used as an early predictor of sepsis, MOD, and mortality in trauma population.

中文翻译：

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重伤患者血清降钙素原测量的预后价值：系统评价

背景重大创伤与脓毒症并发症和多器官功能障碍（MOD）的高发生率相关，这显着影响受伤患者的预后。早期识别有发生创伤后并发症风险的患者对于提供早期治疗和改善结果至关重要。我们试图评估与损伤严重程度、败血症、器官功能障碍和死亡率相关的创伤后血清降钙素原 (PCT) 水平的预后价值。方法我们搜索了 PubMed、MEDLINE、EMBASE、Cochrane 数据库和纳入文章的参考资料。两名研究人员独立确定符合条件的研究并提取数据。我们纳入了评估血清 PCT 水平在预测损伤、败血症、器官功能障碍、重伤成人患者的死亡率和死亡率。结果在 2015 年的引文中，19 项研究（17 项前瞻性；2 项回顾性）符合纳入标准。纳入研究的方法学质量中等。所有研究都显示初始 PCT 水平与损伤严重程度评分 (ISS) 之间存在很强的相关性。16 项研究中有 12 项表明，在创伤后后来发展为败血症的患者中，初始 PCT 水平显着升高。在九项研究中的七项中，PCT 水平似乎是 MOD 的强预测因子。虽然两项研究未显示 PCT 水平与死亡率之间存在关联，但四项研究表明非幸存者与幸存者的 PCT 水平显着升高。一项研究报告，PCT 水平≥ 5 ng/mL 与死亡率显着增加相关（OR 3.65；95% CI 1.03–12.9；p = 0.04）。结论 PCT 有望成为创伤的替代生物标志物。初始峰值 PCT 水平可用作创伤人群中败血症、MOD 和死亡率的早期预测指标。