Novel markers predict death and organ failure following hemorrhagic shock

• The serum concentration of HSP27 and base deficit estimation measured in two groups of patients with hemorrhagic shock (survivors, n=11; vs. Multi Organ Dysfunction Syndrome (MODS)/death, n=6) revealed a statistical significant difference between medians of these groups. The concentrations of ADAMTS13 and sP-Selectin were considerably different between these groups, but not statistically significant. No statistical significant difference was found between these groups for standard protocol testing, such as base deficit estimation, systolic blood pressure, heart rate, and shock index.
• The evaluation of the area under the ROC curve showed that HSP27 performed the best in detecting patients with a higher risk to die or develop MODS with AUC 0.91.
• The cutoff point concentrations, which identify patients who died or developed MODS with 100% sensitivity, have been established for ADAMTS13 concentration, HSP27, sP-Selectin, and BD. No effective cutoff points could be ascertained for ADAMTS13 activity, SI, SBP, StO2 and HR.
• Despite the fact that by using multiple markers we correctly predicted the outcome in all tested patients (17/17 correct predictions), we can only be 95% confident that the classification is correct 80% to 100% of the time due to the low number of tested patients. The sample size is not sufficient to compare use of multiple predictors at this time, and verification of these results must be confirmed by the in larger studies.

BackgroundADAMTS 13, sP-Selectin and HSP27 have been investigated as potential prognostic markers in patients with hemorrhagic shock.MethodsThis study was part of a double-blind, randomized, parallel-group, controlled trial and included seventeen trauma patients presented to ED with severe hemorrhagic. The sera for testing were collected from these patients at the time of admission. Investigators and laboratory personnel performing testing were blinded to the patients' identity and clinical course.ResultsThe prognostic value of ADAMTS13, sP-Selectin, and HSP27 was compared to prognostic value of systolic blood pressure (SBP), base deficit estimation (BD), heart rate (HR), shock index (SI) and tissue oxygen saturation (StO2) by constructing the receiver operation characteristics (ROC). The area under the curve (AUC) of the ROC for HSP27 (0.92) was greater than for SBP (0.45), BD (0.89), HR (0.61), SI (0.45) and StO2 (0.46). AUC for sP-Selectin (0.86) and for ADAMTS13 antigen (0.74) were comparable with BD one, but greater than for the rest of currently used tests.ConclusionSerum concentrations of ADAMTS13, HSP27 and sP-Selectin measured during the admission, appear to be comparable to or better than SBP, BD, SI, HR and StO2 in predicting MODS and death after hemorrhage from trauma. These potential new markers deserve further investigation.