Traumatic Induced Capillary Leak Syndrome is Highly Predictive of Mortality
Grant Bochicchio, MD*, Obeid Ilahi, MD*, Kelly Bochicchio, MD*, Stacey Reese, MD*, Thomas Scalea, MD
University of Maryland, Baltimore, MD
OBJECTIVE(S): To determine whether traumatic induced capillary leak syndrome (TICS) characterized by severe hypoalbuminemia (albumin < 2.0 mg/dl) within 2 hours of injury regardless of hemodynamic instability is predictive of outcome in critically injured trauma patients and whether reversal of this process improves outcome.
METHODS: A prospective study was conducted on 2348 patients admitted to the ICU over a 2 1/2 year period. Serum albumin level was measured within 2 hours post injury. Patients were subsequently monitored over the next 7 days utilizing a computational and graded algorithmic model. Stepwise regression models were performed controlling for age, gender, mechanism, injury severity and APACHE score. ROC curves were used to evaluate the positive predictive value of this algorithm.
RESULTS: 74% of the cohort were male and the majority of patients were admitted for blunt injury (n= 1855 or 79%). The mean age, ISS, and APACHE score were 43 ± 21 years, 27 ± 15, and 13 ± 7 respectively. The overall incidence of TICS was 21%. When analyzed by multiple regression analysis controlling for age, injury severity, APACHE score, and gender, patients with TICS had a significantly higher mortality (RR = 10.1 p<0.001). Patients with severe TICS (albumin level <1 mg/dl) had an overall 70% mortality and a 91% positive predictive value for subsequent mortality if the value failed to improve by more than 50% over the next 72 hours. CONCLUSIONS: TICS is highly predictive of death and poor outcome. Future research directed in reversing this lethal disease process is warranted.
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