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The effect of severe trauma on urinary cyclic AMP in children of different ages
Insights
Urinary cyclic AMP (cAMP) levels increase in children after trauma, with higher levels observed in younger children and those admitted later. This response differs from adults, suggesting age-dependent trauma effects.
Area of Science:
- Pediatrics
- Biochemistry
- Trauma Medicine
Background:
- Urinary cyclic AMP (cAMP) is a biomarker used in clinical studies.
- Trauma significantly impacts physiological responses.
- Age-related differences in physiological responses to trauma are not fully understood.
Purpose of the Study:
- To investigate the age-dependency of urinary cyclic AMP (cAMP) excretion in children following trauma.
- To compare the cAMP response to trauma in children versus adults.
- To analyze the time-course of cAMP excretion after trauma in pediatric patients.
Main Methods:
- Studied urinary cAMP excretion in 97 healthy children and 65 children with trauma.
- Analyzed cAMP levels based on age groups (3 months to 9.5 years and 9.5 to 16 years).
- Monitored cAMP levels at different time points post-trauma and during a five-day follow-up.
Main Results:
- Mean urinary cAMP levels were significantly elevated in traumatized children (44.8% increase).
- Younger children (3 months to 9.5 years) showed a greater cAMP increase (50.0%) compared to older children (36.2%).
- Elevated cAMP levels were more pronounced in children admitted 2-24 hours post-trauma (49.2% increase) versus within 2 hours (31.25%).
- Follow-up showed the highest cAMP excretion on day 1 post-trauma, declining to near-baseline by day 3.
- Children's cAMP response to trauma was more intense and had a different daily pattern compared to previously studied adults.
Conclusions:
- Urinary cAMP excretion in response to trauma is age-dependent in children.
- The intensity and pattern of cAMP response to trauma differ between pediatric and adult populations.
- These findings suggest age influences the physiological response to pathological stimuli, including trauma.
Abstract:
Under routine clinical conditions the urinary excretion of cyclic AMP was studied in 97 healthy children (3 months to 16 years old) and 65 child victims of various forms of trauma and proved to be age-dependent. The mean admission cAMP urinry levels for children of all ages were increased by 44.8% and were time dependent. In 26 injured children (3 months to 9.5 years old) the excretion increased to 12.10 +/-1.29 mumol cAMP/g creatinine as compared to 8.06 +/- 2.25 mumol cAMP/g crEAtinine (50.0%; P less than 0.01) and in 38 children (9.5-16 years) it rose to 6.43 +/- 4.12 from 4.72 mumol +/- 1.10 (36.2%; P less than 0.001). In 23 victims admitted within the first two hours after trauma the cAMP levels were elevated by 31.25% in contrast to 49.2% elevation in those admitted from 2 to 24 h after trauma. In a five-day follow-up of a group of 15 surviving patients the highest excretion of cAMP was found on the first day. It was followed by a steep decline until the values plateaued on the third day at values slightly elevated above control. Compared with the fifth day, the first day excretion expressed as mumol cAMP/24 h was enhanced by 92.3% (P less than 0.01) and as a ratio to creatinine (muol/g creatine) by 52.24% (P less than 0.05. In comparison with injured adults studied previously under analogical conditions, the cAMP excretory response to trauma in children differs in higher intensity (P less than 0.01) and in the nature of the daily pattern starting with the third day. It is pointed out that the intensity of the cAMP response to pathological stimuli may be age-dependent also in other clinical conditions.