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The Role of Troponin in Blunt Cardiac Injury After Multiple Trauma in Humans

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Abstract

Background

The incidence of cardiac injury in immediate fatalities after blunt trauma remains underestimated, and reliable diagnostic strategies are still missing. Furthermore, clinical data concerning heart-specific troponin serum levels, injury severity score (ISS), catecholamine treatment and survival of patients on admission to the hospital have rarely been interrelated so far. Therefore, the object of the present study was to identify predictive parameters for mortality in the context of blunt cardiac injury.

Methods

This retrospective observational study included 173 severely injured patients with an ISS ≥25 admitted to the University Hospital of Ulm, a level 1 trauma center, during 2009–2013 . Furthermore, 83 blunt trauma victims who died before hospital admission were subjected to postmortem examination at the Institute of Legal Medicine, University of Ulm, during 2009–2014. ISS, cardiac injury and associated thoracic injuries were determined in both groups. Furthermore, in the hospitalized patients, serum troponin and IL-6 levels were measured.

Results

Macroscopic heart injury was observed in 18 % of the patients who died at the scene and only in 1 % of the patients admitted to the hospital, indicating that macroscopic heart injury is associated with an immediate life-threatening condition. Troponin levels were elevated in 43 % of the patients after admission to the hospital. Moreover, troponin serum concentrations were significantly higher in patients treated with norepinephrine (26.4 ± 4 ng/l) and in non-survivors (84.9 ± 22.8 ng/l) compared to patients without catecholamines and survivors, respectively.

Conclusions

Macroscopic heart injury was 20 times more frequent in non-survivors than in survivors. Serum troponin levels correlated with mortality after multiple injury and therefore may represent a valuable prognostic marker in trauma patients.

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Authors and Affiliations

  1. Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, Medical School, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany

    Miriam Kalbitz, Jochen Pressmar, Johanna Stecher, Birte Weber, Florian Gebhard & Markus Huber-Lang

  2. Department of Anesthesiology, University of Ulm, Ulm, Germany

    Manfred Weiss

  3. Department of Pediatrics and Adolescent Medicine, University of Ulm, Ulm, Germany

    Stephan Schwarz

  4. Institute of Legal Medicine, University of Ulm, Ulm, Germany

    Erich Miltner

Authors
  1. Miriam Kalbitz
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  2. Jochen Pressmar
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  3. Johanna Stecher
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  4. Birte Weber
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  5. Manfred Weiss
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  6. Stephan Schwarz
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  7. Erich Miltner
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  8. Florian Gebhard
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  9. Markus Huber-Lang
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Corresponding author

Correspondence to Miriam Kalbitz.

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The authors declare no commercial or financial conflicts of interest related to the studies.

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Kalbitz, M., Pressmar, J., Stecher, J. et al. The Role of Troponin in Blunt Cardiac Injury After Multiple Trauma in Humans. World J Surg 41, 162–169 (2017). https://doi.org/10.1007/s00268-016-3650-7

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  • DOI: https://doi.org/10.1007/s00268-016-3650-7

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