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Transthyretin at Admission and Over Time as a Marker for Clinical Outcomes in Critically Ill Trauma Patients: A Prospective Single-Center Study

  • Tobias Haltmeier
  • Kenji InabaEmail author
  • Joseph Durso
  • Moazzam Khan
  • Stefano Siboni
  • Vincent Cheng
  • Beat Schnüriger
  • Elizabeth Benjamin
  • Demetrios Demetriades
Original Scientific Report
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Abstract

Background

Transthyretin (TTR) has been described as a predictor for outcomes in medical and surgical patients. However, the association of TTR on admission and over time on outcomes has not yet been prospectively assessed in trauma patients.

Methods

This is a prospective observational study including trauma patients admitted to the intensive care unit (ICU) of a large Level I trauma center 05/2014–05/2015. TTR levels at ICU admission and all subsequent values over time were recorded. Patients were observed for 28 days or until hospital discharge. The association of outcomes and TTR levels at admission and over time was assessed using multivariable regression and generalized estimating equation (GEE) analysis, respectively.

Results

A total of 237 patients with TTR obtained at admission were included, 69 of whom had repeated TTR measurements. Median age was 40.0 years and median ISS 16.0; 83.1% were male. Below-normal TTR levels at admission (41.8%) were independently associated with higher in-hospital mortality (p = 0.042), more infectious complications (p = 0.032), longer total hospital length of stay (LOS) (p = 0.013), and ICU LOS (p = 0.041). Higher TTR levels over time were independently associated with lower in-hospital mortality (p = 0.015), fewer infections complications (p = 0.028), shorter total hospital and ICU LOS (both p < 0.001), and fewer ventilator days (0.004).

Conclusions

In critically ill trauma patients, below-normal TTR levels at admission were independently associated with worse outcomes and higher TTR levels over time with better outcomes, including lower in-hospital mortality, less infectious complications, shorter total hospital and ICU LOS, and fewer ventilator days. Based on these results, TTR may be considered as a prognostic marker in this patient population.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest or financial ties to disclose.

Ethical approval

This study was approved by the Institutional Review Board of the University of Southern California.

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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Tobias Haltmeier
    • 1
    • 2
  • Kenji Inaba
    • 1
    Email author
  • Joseph Durso
    • 1
  • Moazzam Khan
    • 1
  • Stefano Siboni
    • 1
  • Vincent Cheng
    • 1
  • Beat Schnüriger
    • 2
  • Elizabeth Benjamin
    • 1
  • Demetrios Demetriades
    • 1
  1. 1.Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical CenterUniversity of Southern CaliforniaLos AngelesUSA
  2. 2.Division of Acute Care Surgery, Department of Visceral Surgery and MedicineInselspital, Bern University HospitalBernSwitzerland

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