Reprioritization of hepatic plasma protein release in trauma and sepsis
G. Sganga, J. H. Siegel, G. Brown, B. Coleman, C. E. Wiles 3rd, H. Belzberg, S. Wedel and R. Placko
We studied the temporal pattern of seven hepatic synthesized plasma
proteins in 26 severely injured patients beginning in the immediate
posttrauma period. Clinical sepsis developed in ten patients between three
and eight days after injury, and 16 patients had nonseptic courses. In the
initial five days after injury, except for albumin, all acute-phase protein
levels rose. However, if sepsis developed, C-reactive protein, fibrinogen,
ceruloplasmin, and alpha 1-antitrypsin levels continued to be elevated
after the initial five posttrauma days, while transferrin, albumin, and
alpha 2-macroglobulin levels fell. This differential response became more
extreme as sepsis progressed. Covariance analysis of the regression of the
five true acute-phase hepatic proteins on C-reactive protein showed that,
when sepsis occurred after major traumatic injury, the C-reactive protein
rise was associated with a significant reprioritization of hepatic
acute-phase plasma protein release. This reprioritization response seems to
be both a predictor of sepsis as well as a measure of the adequacy of the
host response to trauma and sepsis.
