Alpha-melanocyte stimulating hormone in critically injured trauma patients
S Rob Todd1, Lillian S Kao, Anna Catania
1Department of Surgery, Weill Medical College of Cornell University, Houston, Texas 77030, USA. srtodd@tmh.tmc.edu
Background:
Alpha-melanocyte stimulating hormone (alpha-MSH) is a neuropeptide which modulates inflammation. Prior studies have documented decreased alpha-MSH concentrations in patients with acute traumatic brain injury and subarachnoid hemorrhage. We hypothesized that alpha-MSH levels would be decreased in critically injured patients and that this would correlate with poor outcome.
Methods:
We performed a retrospective review of prospectively collected data more than 12 months ending December 2005. alpha-MSH concentrations were measured in major torso trauma patients (excluding severe head injuries) who underwent standardized shock resuscitation. alpha-MSH concentrations were measured every 4 hours for the first 24 hours of intensive care unit admission and daily thereafter for hospital days 2 to 5. Controls were similarly aged, healthy volunteers. Outcomes measured included lengths of stay, infectious morbidity, and the incidence of multiple organ failure (MOF) and mortality.
Results:
Fifty-one trauma patients were studied with a median age of 33 (22-54) years. Seventy-five percent were male and 82% sustained blunt trauma. The median Injury Severity Score was 25 (16-34). Eighteen percent of the patients developed MOF, 18% died, and 24% developed MOF and died. The mean initial (first value on the first day) alpha-MSH concentration was significantly lower than in controls (15.9 pg/mL +/- 7.6 pg/mL vs. 26.1 pg/mL +/- 7.4 pg/mL, p = 0.0008) and did not change significantly during the 5-day study period. On univariate and adjusted multivariate analyses, initial alpha-MSH concentrations did not predict either MOF or mortality.
Conclusions:
The current study is the first to document significantly decreased alpha-MSH concentrations in critically injured trauma patients as compared with controls. Furthermore, alpha-MSH concentrations remained so throughout the study period.
Insights
Critically injured trauma patients have significantly lower alpha-melanocyte stimulating hormone (alpha-MSH) levels compared to healthy individuals. These decreased alpha-MSH concentrations did not predict outcomes like multiple organ failure or mortality in the study.
Area of Science:
- Neuropeptide function in critical illness
- Inflammation modulation in trauma
Background:
- Alpha-melanocyte stimulating hormone (alpha-MSH) is a neuropeptide involved in inflammation.
- Previous research indicated lower alpha-MSH in traumatic brain injury and subarachnoid hemorrhage.
- This study investigated alpha-MSH levels in major torso trauma patients.
Purpose of the Study:
- To determine if alpha-melanocyte stimulating hormone (alpha-MSH) levels are decreased in critically injured trauma patients.
- To assess the correlation between alpha-MSH concentrations and patient outcomes, including organ failure and mortality.
Main Methods:
- Retrospective review of prospectively collected data from trauma patients (excluding severe head injuries).
- Measurement of alpha-MSH concentrations at intervals during the first 5 days of ICU admission.
- Comparison of patient alpha-MSH levels with those of healthy controls.
Main Results:
- Critically injured trauma patients exhibited significantly lower initial alpha-MSH concentrations compared to controls (15.9 pg/mL vs. 26.1 pg/mL).
- Alpha-MSH levels remained consistently low throughout the 5-day study period.
- Initial alpha-MSH concentrations did not predict the development of multiple organ failure (MOF) or mortality on univariate or multivariate analyses.
Conclusions:
- This study provides the first evidence of significantly decreased alpha-melanocyte stimulating hormone (alpha-MSH) concentrations in critically injured trauma patients.
- Sustained low alpha-MSH levels were observed throughout the intensive care unit stay in trauma patients.
