Early changes of plasma angiopoietin-2 in patients with multiple trauma

doi:10.5847/wjem.j.1920-8642.2011.04.008

Abstract

Abstract:

BACKGROUND: This study was undertaken to investigate the early changes of plasma levels of angiopoietin-2 (Ang-2) in patients with multiple trauma and the relations of plasma Ang-2, endothelial injury, and prognosis.
METHODS: This study comprised 59 patients with multiple trauma who had been treated at the emergency department of Liao Cheng People′s Hospital from January 2008 to January 2010. Among them, 36 were male and 23 female. Their average age was 32.3±11.5 years. The 59 patients were divided into a severe trauma group (ISS≥16 points, 29 patients) and a slight trauma group (ISS<16 points, 30 patients) by injury severity score (ISS). Thirty healthy people aged more than 18 years with an average of 33.5±10.6 years served as controls (19 male and 11 female). Peripheral blood (10 mL) was collected within 10 minutes after the patients arrived at the emergency department, and plasma was separated from the blood. Enzyme-linked immunosorbent assay (ELISA) was applied to detect the levels of angiopoietin 2, thrombomodulin (TM), and Von willebrand factor (vWF).
RESULTS: The level of Ang-2 in the severe trauma group (ISS score≥16 points) was significantly higher than that in the slight trauma group (ISS score<16 points) (P<0.05). The levels in the two groups were significantly higher than those in the control group (P<0.05). The levels of angiopoietin-2 in deaths were significantly higher than those in survivors (P<0.05). The levels of angiopoietin-2 were significantly correlated with the levels of vWF and TM (P<0.05).
CONCLUSIONS: The plasma levels of Ang-2 are significantly higher after multiple trauma, and correlated with the degree of trauma severity. The levels of angiopoietin-2 are correlated with endothelial injury after multiple trauma, and are important values for the prognosis of patients with multiple trauma.

Key words: Multiple trauma, Angiopoietin-2, Endothelial injury, Prognosis

Hai-bin Weng, Sen Li. Early changes of plasma angiopoietin-2 in patients with multiple trauma[J]. World Journal of Emergency Medicine, 2011, 2(4): 287-290.

Figures/Tables 1

References 17

1	Parikh SM, Mammoto T, Schultz A, Yuan HT, Christiani D, Karumanchi SA, et al. Excess circulating angiopoietin-2 may contribute to pulmonary vascular leak in sepsis in humans. PLoS Med 2006; 3:e46. pmid: 16417407
2	Zhang WQ, Liu C, Sun TS, Zhao J, Han JQ, Yang YH, et al. Physical and mental health status of soldiers responding to the 2008 Wenchuan earthquake. Aust N Z J Public Health 2011; 35:207-211. doi: 10.1111/j.1753-6405.2011.00680.x pmid: 21627719
3	Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma 2006; 60:S3-11. doi: 10.1097/01.ta.0000199961.02677.19
4	Ikegami K, Suzuki Y, Yukioka T, Matsuda H, Shimazaki S. Endothelial cell injury, as quantified by the soluble thrombomodulin level, predicts sepsis/multiple organ dysfunction syndrome after blunt trauma. J Trauma 1998; 44:789-794. pmid: 9603079
5	Qin YW, Ye P, He JQ, Sheng L, Wang LY, Du J. Simvastatin inhibited cardiac hypertrophy and fibrosis in apolipoprotein E-deficient mice fed a "Western-style diet" by increasing PPAR α and γ expression and reducing TC, MMP-9, Cat S levels. Acta Pharmacol Sin 2010; 31: 1350-1358. Epub 2010 Sep 13. doi: 10.1038/aps.2010.109 pmid: 20835264
6	Aird WC. The role of the endothelium in severe sepsis and multiple organ dysfunction syndrome. Blood 2003; 101:3765-3777. pmid: 12543869
7	Koh GY, Kim I, Kwak HJ, Yun MJ, Leem JC. Biomedical significance of endothelial cell specific growth factor, angiopoietin. Exp Mol Med 2002; 34:1-11. pmid: 11989972
8	Roviezzo F, Tsigkos S, Kotanidou A, Bucci M, Brancaleone V, Cirino G, et al. Angiopoietin-2 causes inflammation in vivo by promoting vascular leakage. J Pharmacol Exp Ther 2005; 314:738-744. pmid: 15870388
9	Orfanos SE, Kotanidou A, Glynos C, Athanasiou C, Tsigkos S, Dimopoulou I, et al. Angiopoietin-2 is increased in severe sepsis: correlation with inflammatory mediators. Crit Care Med 2007; 35:199-206.
10	Bhandari V, Choo-Wing R, Lee CG, Zhu Z, Nedrelow JH, Chupp GL, et al. Hyperoxia causes angiopoietin 2-mediated acute lung injury and necrotic cell death. Nat Med 2006; 12:1286-1293. pmid: 17086189
11	van der Heijden M, van Nieuw Amerongen GP, Koolwijk P, van Hinsbergh VW, Groeneveld AB. Angiopoietin-2, permeability oedema, occurrence and severity of ALI/ARDS in septic and non-septic critically ill patients. Thorax 2008; 63:903-909. doi: 10.1136/thx.2007.087387 pmid: 18559364
12	van der Heijden M, Pickkers P, van Nieuw Amerongen GP, van Hinsbergh VW, Bouw MP, van der Hoeven JG, et al. Circulating angiopoietin-2 levels in the course of septic shock: relation with fluid balance, pulmonary dysfunction and mortality. Intensive Care Med 2009; 35:1567-1574. pmid: 19551369
13	Reinhart K, Bayer O, Brunkhorst F, Meisner M. Markers of endothelial damage in organ dysfunction and sepsis. Crit Care Med 2002; 30:S302-S312. pmid: 12004252
14	Rondaij MG, Bierings R, Kragt A, van Mourik JA, Voorberg J. Dynamics and plasticity of Weibel-Palade bodies in endothelial cells. Arterioscler Thromb Vasc Biol 2006; 26:1002-1007. doi: 10.1161/01.ATV.0000209501.56852.6c pmid: 16469951
15	Kümpers P, Lukasz A, David S, Horn R, Hafer C, Faulhaber-Walter R, et al. Excess circulating angiopoietin-2 is a strong predictor of mortality in critically ill medical patients. Crit Care 2008; 12:R147. doi: 10.1186/cc7130 pmid: 19025590
16	Gallagher DC, Parikh SM, Balonov K, Miller A, Gautam S, Talmor D, et al. Circulating angiopoietin 2 correlates with mortality in a surgical population with acute lung injury/adult respiratory distress syndrome. Shock 2008; 29:656-661. pmid: 18091573
17	Porter JM, Ivatury RR, Azimuddin K, Swami R. Antioxidant therapy in the prevention of organ dysfunction syndrome and infectious complications after trauma: early results of a prospective randomized study. Am Surg 1999; 65:478-483. pmid: 10231223

Groups	n	Ang-2 (pg/mL)	vWF(%)	TM(ng/mL)
Severe trauma	29	2900±210^*#	270±65	58±10
Slight trauma	30	2100±190^*	210±60	49±7
Control	30	1900±200	120±40	28±5

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