Abstract P116: Prospective Evaluation of Nuclear Factor Kappa-B and Non-Invasive Hemodynamic Estimates During the Acute Phase of Trauma Resuscitation
Introduction: Several animal studies demonstrated that tolerance to hemorrhage is associated with nuclear factor kappa-B (nfkb) activation; with decreased activity conferring a benefit.
Objective: Determining if blood draws equivalent to wasted amounts of blood (5ml) allow measurement of nfkb with ELISA in trauma patients. Also, to evaluate the predictive utility of this assay on clinical outcomes.
Methods: Setting: An academic level-1 trauma center with significant penetrating trauma. Trauma patients were included if they had either pre-hospital hypotension or 120 bpm heart rate. Blood draws occurred on immediate arrival to the emergency room and approximately 1 hour later. A doppler ultrasound (USCOM, AUS) was used to serially measure stroke volume to estimate cardiac output and other hemodynamic characteristics. Whole cell extract of isolated monocytes were placed in a freezer to −80 C within 30 minutes of blood draw. A commercial ELISA kit (Active Motif, USA) was used to quantify nfkb activation (duplicate sampling). Linear regression and ANOVA were used determine associations. This study was IRB approved for waiver of consent.
Results: We report on 20 trauma patients, age ranged 7 to 86 years old, 40% penetrating trauma, 65% received immediate operations. The initial nfkb activity was detectable and significantly elevated compared to non-injured control (range 2-fold to 6-fold over control). Two patients died due to hemorrhage their drop in nfkb was 1–3 fold compared to 0-fold for survivors (p=0.18). Initial nfkb was not predictive of mortality, nor for patients requiring transfusion. Changes in nfkb were associated with changes in cardiac output and systemic vascular resistance, yet this was likely due to a single observation. The highest nfkb activation (6 fold) was observed in a 7 year old patient.
Conclusion: This study demonstrates that nfkb activity is detectable using amounts of blood equivalent to ‘wasted’ volumes. The significant increase activity is consistent with severe trauma. However, we did not observe a significant prediction in mortality or requirement for blood transfusion. Further study is required to determine if nfkb activation differs with age given the observation of the highest activity with the youngest patient.