Document Detail


Prognostic value of an early soluble L-selectin (sCD62L) assay for risk assessment in blunt multiple trauma: a metaanalysis.
MedLine Citation:
PMID:  15550474     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: After severe trauma, decreased plasma concentrations of the soluble adhesion molecule L-selectin (sCD62L) have been linked to an increased incidence of lung failure and multiorgan dysfunction syndrome (MODS). Individual studies have had conflicting results, however. We examined multiple studies in an attempt to determine whether early sCD62L concentrations are predictive of major complications after severe trauma. METHODS: We performed a systematic review of six electronic databases and a manual search for clinical studies comparing outcomes of multiply injured patients (Injury Severity Score > or =16) depending on their early sCD62L blood concentrations. Because of various outcome definitions, acute lung injury (ALI) and adult respiratory distress syndrome (ARDS) were studied as a composite endpoint. Weighted mean differences (WMDs) in sCD62L concentrations were calculated between individuals with and without complications by fixed- and random-effects models. RESULTS: Altogether, 3370 citations were identified. Seven prospective studies including 350 patients were eligible for data synthesis. Published data showed the discriminatory features of sCD62L but did not allow for calculation of measures of test accuracy. Three of four studies showed lower early sCD62L concentrations among individuals progressing to ALI and ARDS (WMD = -229 microg/L; 95% confidence interval, -476 to 18 microg/L). No differences in sCD62L concentrations were noted among patients with or without later MODS. Nonsurvivors had significantly lower early sCD62L plasma concentrations (WMD = 121 microg/L; 95% confidence interval, 63-179 microg/L), but little information was available on potential confounders in this group. CONCLUSIONS: Early decreased soluble L-selectin concentrations after multiple trauma may signal an increased likelihood of lung injury and ARDS. The findings of this metaanalysis warrant a large cohort study to develop selectin-based models targeting the risk of inflammatory complications.
Authors:
Dirk Stengel; Kai Bauwens; Didier Keh; Herwig Gerlach; Axel Ekkernkamp; Rudolf Tauber; Thoralf Kerner
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2004-11-18
Journal Detail:
Title:  Clinical chemistry     Volume:  51     ISSN:  0009-9147     ISO Abbreviation:  Clin. Chem.     Publication Date:  2005 Jan 
Date Detail:
Created Date:  2004-12-22     Completed Date:  2005-02-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9421549     Medline TA:  Clin Chem     Country:  United States    
Other Details:
Languages:  eng     Pagination:  16-24     Citation Subset:  IM    
Affiliation:
Clinical Epidemiology Division, Department of Orthopedic and Trauma Surgery, Unfallkrankenhaus Berlin, 12683 Berlin, Germany. dirk.stengel@ukb.de
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MeSH Terms
Descriptor/Qualifier:
Humans
L-Selectin / blood*
Multiple Trauma / complications,  diagnosis*
Predictive Value of Tests
Prospective Studies
Respiratory Distress Syndrome, Adult / diagnosis,  etiology
Risk Assessment
Solubility
Wounds, Nonpenetrating / complications,  diagnosis*
Chemical
Reg. No./Substance:
126880-86-2/L-Selectin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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