Postinjury serum secretory phospholipase A2 correlates with hypoxemia and clinical status at 72 hours

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Abstract
Background Although trauma patients often suffer direct lung damage, an equally destructive mechanism of lung injury involves postinjury systemic inflammation. We postulate that secretory phospholipase A 2 (sPLA 2) release induced by trauma relates to systemic inflammation that compromises both lung function and clinical status after injury. The objectives of this study were: to relate Injury Severity Score to postinjury sPLA 2; to determine whether circulating sPLA 2 relates to pulmonary oxygenation and compliance; and to determine whether early or persistent increases in sPLA 2 are associated with abnormal chest x-ray at 72 hours after injury. Study design The prospective cohort study comprised 54 consecutive intensive care admissions in patients with traumatic injury admitted over a 6-month period from November 1, 1996, to May 1, 1997. Results Postinjury peak sPLA 2 values were associated with increased ISS (r = 0.49, r 2 = 0.24, p < 0.001). Patients with elevated sPLA 2 had poor oxygenation compared with those with normal sPLA 2 levels (Pa0 2/Fi0 2 ratio 164 ± 16 versus 260 ± 26 mmHg [mean ± SEM], p < 0.01) and also required additional PEEP (5.5 ± 0.9 versus 2.5 ± 0.4 cm H 2O, p = 0.01). Secretory PLA 2 levels in patients with abnormal chest x-ray 72 hours after injury were higher (1.08 ± 0.2 versus 0.34 ± 0.1 activity units, p < 0.001) than levels seen in patients with normal x-rays. Conclusions Increasing injury magnitude is associated with elevated sPLA 2 levels, and increased sPLA 2 is related to postinjury hypoxemia and clinical status.

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