THROMBOSIS RESEARCH 65; 809-814,1992 0049-3848/92 $5.00 + .OOPrinted in the USA. Copyright (c) 1992 Pergamon Press Ltd. All rights reserved.
BRIEF
COMMUNICATION
FACTOR XIIIAJXIIIB, RATIO IN SZVBRZLY TRAUMATIZED WITH SOFT TISSUE TRAOXA
PATIENTS
A. Seekamp*, M. Barthels#, J.A. Sturm* *Dept. of Trauma Surgery, #Division of Hematology and Oncology, Hannover Medical School, Konstanty Gutschow Str., D-3000 Hannover (Received 30.7.1991; accepted in revised form 24.12.1991 by Editor H. Graeff)
INTRODUCTION The subunit Factor XIIIA, is dissociated by the actions of thrombin as well as Ca2+ from its carrier protein XIIIBl during the coagulation process and is bound to fibrin (1). A low ratio of the trace protein factor XIIIA,/factor XIIIB, should therefore be indicative for intravascular coagulation. Expecting low ratios in patients with extensive tissue trauma, factor XIIIA, and XIIIBz were investigated in polytraumatized patients. Unexpectedly normal or even high ratios were found instead. Comparing factor XIIIA2/XIIIB2 ratios to various laboratory and clinical parameters a significant increase of factor XIIIA,/XIIIB, ratio was found to go parallel to the extent of soft tissue damage but not to parameters indicating multiple organ failure (MOF) or adult respiratory distress syndrom (AHDS).
METHODS In 24 severely traumatized patients, mean injury severity score (ISS) (2) of 45.9k6.2, we monitored, besides clinical parameters, Lactatedehydrogenase (LDH), Creatine phosphokinase (CK) as well as factor XIIIA, and XIIIB, over a 14 day period of time. Plasma and serum samples were collected right after hospital admission, furthex in 6 hours intervals for the first two days, followed by 24 hours intervals for the rest of the study.
Key words: factor XIIIA,, factor XIIIB,, soft tissue trauma, 809
FACTOR
810
XIIIA~XIIIB,
IN TRAUMA
Vol. 65,No.6
patients were According to the Hannover classification (3) divided in one group (gr. A, n=14), including soft tissue trauma of 2. degree (severe damage of subcutaneous and muscle tissue) and 3. degree (same as 2. degree plus vessel and nerve damage), and a second group (gr. B, n=lO) including only 1. degree tissue trauma and all other without any tissue damage. Factor XIIIAz and factor XIIIB, (normal range SO-150%) were assayed by Laurel1 (4) innnunoelectrophoresisusing specific polyclonal antiserum (Behringwerke, Marburg FRG). LDH and CK were measured to find out whether or not the separation of the patients into the mentioned two groups could also be based on these enyzmes. For considering the ability of the liver for protein synthesis we also monitored serum protein levels. Data are presented as mean values f SD, for statistical analysis Students T-test was used, ~10.05 was considered to be significant and is indicated by * in the graphs. RESULTS The ISS for the tissue trauma itself was 12.6k3.2 for group A and 3.9k1.2 for group B, which is significant different. Whereas the total ISS, including all body injuries, was 47.1k5.3 in group Aand 44.4k4.8 in group B.
%
1001
Group B
20&l 0
.
l”“li1”““J””
..c.s.r..
12h 24h 36h 48h 4d
6d
8d 1Od 12d 14dt
Fig.1: Factor XIIIA, levels 'in polytraumatized patients with and without severe tissue trauma.
.
’
Vol. 65, No. 6
FACTOR XIIIA.jXIIIB,
IN TRAUMA
811
Of the monitored parameters CK had an initial peak of 1600 U/l in both groups followed by a continously parallel decrease to 120 U/l on the day 14. LDH did increase initially to 450 U/l within 24h and from a level of 450 U/l on day 4 further up to 600 U/l on day 8. In both groups values remained on this level until day 14. In both parameters no significant differences between the two groups could be observed. Factor XIIIA, (Fig.11 was decreased to levels about 40% in both groups at hospital admission, slightly more so in group A. During the following hours and days the mean course of factor XIIIA, was almost indentical in both groups with a rise at 6 hours after hospital admission, decreasing again till day 4 and then increasing to normal values after day 8.
%
looGroupA
90-
GroupB ."*.""....
6070- .]
*
.T '"' 60 - ~, !_, qIAR/
I I
*
Fig.2: Factor XIIIB, levels in polytraumatized patients with and without severe tissue trauma. In contrast to factor XIIIA, the subunit factor XIIIB, showed a remarkable difference between the two groups with a constant lower concentration in group A than in group B (Fig.2). Comparing factor XIIIA, and XIIIB, within each group it becomes evident that in group B both factors are almost identical, with higher values of XIIIA, (not significant) on 24h to 48h. In group A also both curves have a parallel tendency but except the first 18h factor XIIIA, is about lo-15% higher than factor XIIIB, until day 10 and even 20% higher until day 14 (p
BRIEF
COMMUNICATION
FACTOR XIIIAJXIIIB, RATIO IN SZVBRZLY TRAUMATIZED WITH SOFT TISSUE TRAOXA
PATIENTS
A. Seekamp*, M. Barthels#, J.A. Sturm* *Dept. of Trauma Surgery, #Division of Hematology and Oncology, Hannover Medical School, Konstanty Gutschow Str., D-3000 Hannover (Received 30.7.1991; accepted in revised form 24.12.1991 by Editor H. Graeff)
INTRODUCTION The subunit Factor XIIIA, is dissociated by the actions of thrombin as well as Ca2+ from its carrier protein XIIIBl during the coagulation process and is bound to fibrin (1). A low ratio of the trace protein factor XIIIA,/factor XIIIB, should therefore be indicative for intravascular coagulation. Expecting low ratios in patients with extensive tissue trauma, factor XIIIA, and XIIIBz were investigated in polytraumatized patients. Unexpectedly normal or even high ratios were found instead. Comparing factor XIIIA2/XIIIB2 ratios to various laboratory and clinical parameters a significant increase of factor XIIIA,/XIIIB, ratio was found to go parallel to the extent of soft tissue damage but not to parameters indicating multiple organ failure (MOF) or adult respiratory distress syndrom (AHDS).
METHODS In 24 severely traumatized patients, mean injury severity score (ISS) (2) of 45.9k6.2, we monitored, besides clinical parameters, Lactatedehydrogenase (LDH), Creatine phosphokinase (CK) as well as factor XIIIA, and XIIIB, over a 14 day period of time. Plasma and serum samples were collected right after hospital admission, furthex in 6 hours intervals for the first two days, followed by 24 hours intervals for the rest of the study.
Key words: factor XIIIA,, factor XIIIB,, soft tissue trauma, 809
FACTOR
810
XIIIA~XIIIB,
IN TRAUMA
Vol. 65,No.6
patients were According to the Hannover classification (3) divided in one group (gr. A, n=14), including soft tissue trauma of 2. degree (severe damage of subcutaneous and muscle tissue) and 3. degree (same as 2. degree plus vessel and nerve damage), and a second group (gr. B, n=lO) including only 1. degree tissue trauma and all other without any tissue damage. Factor XIIIAz and factor XIIIB, (normal range SO-150%) were assayed by Laurel1 (4) innnunoelectrophoresisusing specific polyclonal antiserum (Behringwerke, Marburg FRG). LDH and CK were measured to find out whether or not the separation of the patients into the mentioned two groups could also be based on these enyzmes. For considering the ability of the liver for protein synthesis we also monitored serum protein levels. Data are presented as mean values f SD, for statistical analysis Students T-test was used, ~10.05 was considered to be significant and is indicated by * in the graphs. RESULTS The ISS for the tissue trauma itself was 12.6k3.2 for group A and 3.9k1.2 for group B, which is significant different. Whereas the total ISS, including all body injuries, was 47.1k5.3 in group Aand 44.4k4.8 in group B.
%
1001
Group B
20&l 0
.
l”“li1”““J””
..c.s.r..
12h 24h 36h 48h 4d
6d
8d 1Od 12d 14dt
Fig.1: Factor XIIIA, levels 'in polytraumatized patients with and without severe tissue trauma.
.
’
Vol. 65, No. 6
FACTOR XIIIA.jXIIIB,
IN TRAUMA
811
Of the monitored parameters CK had an initial peak of 1600 U/l in both groups followed by a continously parallel decrease to 120 U/l on the day 14. LDH did increase initially to 450 U/l within 24h and from a level of 450 U/l on day 4 further up to 600 U/l on day 8. In both groups values remained on this level until day 14. In both parameters no significant differences between the two groups could be observed. Factor XIIIA, (Fig.11 was decreased to levels about 40% in both groups at hospital admission, slightly more so in group A. During the following hours and days the mean course of factor XIIIA, was almost indentical in both groups with a rise at 6 hours after hospital admission, decreasing again till day 4 and then increasing to normal values after day 8.
%
looGroupA
90-
GroupB ."*.""....
6070- .]
*
.T '"' 60 - ~, !_, qIAR/
I I
*
Fig.2: Factor XIIIB, levels in polytraumatized patients with and without severe tissue trauma. In contrast to factor XIIIA, the subunit factor XIIIB, showed a remarkable difference between the two groups with a constant lower concentration in group A than in group B (Fig.2). Comparing factor XIIIA, and XIIIB, within each group it becomes evident that in group B both factors are almost identical, with higher values of XIIIA, (not significant) on 24h to 48h. In group A also both curves have a parallel tendency but except the first 18h factor XIIIA, is about lo-15% higher than factor XIIIB, until day 10 and even 20% higher until day 14 (p
