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World Journal of Surgery

, Volume 12, Issue 2, pp 211–216 | Cite as

Estimation of serum complement and its role in management of trauma

  • M. M. Kapur
  • M. Gidh
Original Scientific Reports

Abstract

Serum samples of traumatized (16) and operated (31) patients were analyzed to determine C3 levels and activation. It was found that in the immediate postinjury and postoperative periods, serum C3 activation occurred with a fall in C3 levels. The degree of serum C3 depletion was directly related to the severity of injury, as assessed by the injury severity score (ISS), and to the extent of surgical procedure performed, as assessed by the total duration of surgery and total blood loss. The mean ISS of patients with activated complement was 20.3, in comparison with the ISS of those in whom complement was not activated (mean ISS, 6.6;p<0.01). The mean serum C3 level of patients with ISS≥12 was 80.3 mg% in comparison with the mean C3 level (110.2 mg%) of those with ISS<12(p <0.01).

Serial assay for serum C3 levels at 24-hour intervals in uncomplicated cases revealed a gradual return of the levels to near normal values over a period of several days. Failure to return to normal levels at the expected time invariably indicated complications and, in all such patients, an occult septic focus was either discovered or it revealed itself during the subsequent period of observation. Resolution of septic complication by therapeutic intervention led to a prompt return of the levels to normal. One patient ultimately succumbed to sepsis and had persistently low C3 levels until death.

Serial serum C3 estimation is recommended here as a simple, effective, and inexpensive parameter for feedback information in the management of traumatized and operated patients.

Keywords

Injury Severity Score Total Blood Loss Resta Serial Serum Uncomplicated Case 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Des échantillons de sérum de 16 victimes de traumatisme et de 31 opérés ont été prélevés pour déterminer les taux et l'activation du C3. Il fut constaté immédíatement après le traumatisme ou l'opération une activation et une chute des niveaux de C3. L'intensité de la déplétion fut en relation directe avec l'importance de l'agression (déterminée par le test de la gravité du traumatisme: ISS), et l'importance de l'intervention appréciée en fonction de la durée de l'opération et de la perte de sang. La moyenne du test ISS chez les sujets dont le complément était activé fut de 20.3 alors qu'elle fut de 6.6 (p}<0.01) quand il n'était pas activé. Le taux moyen de complément sérique fut de 80.3 mg% quand le test était égal ou supérieur à 12 alors qu'il fut de 110.2 mg% (p}<0.01) quand il n'était pas activé.

Le dosage des taux de C3 sérique à intervalle de 24 heures démontra un retour progressif à la normale après plusieurs jours dans les cas non compliqués. Au contraire l'absence de normalisation témoigne de l'existence d'une complication en particulier d'un foyer septique occulte qui fut recherché et découvert ou qui se manifesta de lui-mÊme pendant la période d'observation. Le traitement chirurgical de ce foyer entraÎna un retour rapide à un taux normal du C3 sérique. Chez un patient qui succomba à l'infection ce taux resta invariablement bas.

La détermination du taux de C3 à intervalles réguliers est donc à recommander car elle constitue une méthode d'appréciation de la gravité d'un traumatisme ou d'une intervention et permet de diriger le traitement en fontion de ses données.

Resumen

Muestras de suero de pacientes traumatizados (16) y operados (31) fueron analizadas para determinar los niveles y activación de C3. Se encontró en los períodos postraumáticos y postoperatorios inmedíatos la activación de C3 con un descenso en su nivel de concentración sérica. El grado de depleción sérica de C3 apareció directamente relacionado con la gravedad de la lesión, segÚn el índice de severidad de la injuria (ISS), y con la magnitud del procedimiento quirÚrgico efectuado, segÚn su duración y la pérdida total de sangre. El ISS promedio de los pacientes con activación del complemento fue de 20.3, en comparaciÔn con el ISS de los pacientes que no exhibieron activación del complemento (ISS promedio, 6.6;p}<0.01). El nivel promedio de C3 de los pacientes con ISS ≥ 12 fue 80.3 mg%, en comparaciÔn con el nivel promedio de 110.2 mg% en pacientes con ISS <12 (p<0.01).

La determinación seriada de los niveles séricos de C3 a intervalos de 24 horas en casos no complicados reveló un retorno gradual a niveles casi normales en un plazo de varios días. El no retorno a nivelés normales en el plazo esperado fue invariablemente indicativo de complicaciones y en la totalidad de los casos se evidenció un foco séptico. La resolución de la complicación séptica medíante intervención terapéutica dió lugar a un pronto retorno a nivelés normales. Un paciente que finalmente sucumbió por sepsis mantuvo bajos nivelés de C3 hasta el final.

Se recomienda la determinación seriada del nivel sérico de C3 como un parámetro efectivo y económico de predicción de complicaciones sépticas en pacientes traumatizados y operados.

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Copyright information

© Société Internationale de Chirurgie 1988

Authors and Affiliations

  • M. M. Kapur
    • 1
  • M. Gidh
    • 1
  1. 1.Departments of Surgery and BiochemistryAll India Institute of Medical SciencesAnsari Nagar, New DelhiIndia

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