Shock-Induced Endothelial Dysfunction is Present in Patients With Occult Hypoperfusion After Trauma

Area of Science:

• Trauma research
• Endothelial dysfunction markers
• Hemodynamic monitoring

Background:

• Shock-induced endothelial dysfunction, indicated by elevated soluble thrombomodulin (sTM) and syndecan-1 (Syn-1), correlates with poor trauma outcomes.
• The link between overt shock and endothelial dysfunction is established, but its association with occult hypoperfusion (OH) remains unclear.

Purpose of the Study:

• To investigate whether OH, defined as hypoperfusion with normal vital signs, is associated with endothelial dysfunction in trauma patients.
• To test the hypothesis that sTM and Syn-1 levels are elevated in patients with OH compared to those with normal perfusion.

Main Methods:

• A single-center study analyzed 520 trauma patients activated for highest-level trauma care between 2012 and 2016.
• Plasma sTM and Syn-1 were measured upon trauma bay arrival using enzyme-linked immunosorbent assay.
• Shock was defined by systolic blood pressure <90 mmHg or heart rate ≥120 bpm; OH was defined by systolic blood pressure ≥90, heart rate <120, and base excess ≤-3.

Main Results:

• 35% of patients presented with OH and 26% with shock; demographics were similar across groups.
• Patients with OH showed elevated sTM (0.97 ng/mL increase, p=0.001) and Syn-1 (14.3 ng/mL increase, p=0.08) compared to normal perfusion.
• Shock was also associated with increased sTM (0.64 increase, p=0.04) and Syn-1 (23.6 ng/mL increase, p=0.008).

Conclusions:

• Occult hypoperfusion at arrival is associated with elevated sTM and Syn-1, signifying endothelial dysfunction in trauma patients.
• These findings suggest that interventions aimed at stabilizing the endothelium could benefit injured patients exhibiting hypoperfusion, irrespective of their vital signs.