TY - JOUR
T1 - Prehospital plasma is associated with distinct biomarker expression following injury
AU - PAMPer study group
AU - Gruen, Danielle S.
AU - Brown, Joshua B.
AU - Guyette, Francis X.
AU - Vodovotz, Yoram
AU - Johansson, Pär I.
AU - Stensballe, Jakob
AU - Barclay, Derek A.
AU - Yin, Jinling
AU - Daley, Brian J.
AU - Miller, Richard S.
AU - Harbrecht, Brian G.
AU - Claridge, Jeffrey A.
AU - Phelan, Herb A.
AU - Neal, Matthew D.
AU - Zuckerbraun, Brian S.
AU - Billiar, Timothy R.
AU - Sperry, Jason L.
N1 - Publisher Copyright:
© 2020, American Society for Clinical Investigation.
PY - 2020/4/23
Y1 - 2020/4/23
N2 - BACKGROUND. Prehospital plasma improves survival in severely injured patients transported by air ambulance. We hypothesized that prehospital plasma would be associated with a reduction in immune imbalance and endothelial damage. METHODS. We sampled blood from 405 trauma patients enrolled in the Prehospital Air Medical Plasma (PAMPer) trial upon hospital admission (0 hours) and 24 hours post admission across 6 U.S. sites. We assayed samples for 21 inflammatory mediators and 7 markers associated with endothelial function and damage. We performed hierarchical clustering analysis (HCA) of these biomarkers of the immune response and endothelial injury. Regression analysis was used to control for differences across study and to assess any association with prehospital plasma resuscitation. RESULTS. HCA distinguished two patient clusters with different injury patterns and outcomes. Patients in cluster A had greater injury severity and incidence of blunt trauma, traumatic brain injury, and mortality. Cluster A patients that received prehospital plasma showed improved 30-day survival. Prehospital plasma did not improve survival in cluster B patients. In an adjusted analysis of the most seriously injured patients, prehospital plasma was associated with an increase in adiponectin, IL-1β, IL-17A, IL-23, and IL-17E upon admission, and a reduction in syndecan-1, TM, VEGF, IL-6, IP-10, MCP-1, and TNF-α, and an increase in IL-33, IL-21, IL-23, and IL-17E 24 hours later. CONCLUSION. Prehospital plasma may ameliorate immune dysfunction and the endotheliopathy of trauma. These effects of plasma may contribute to improved survival in injured patients.
AB - BACKGROUND. Prehospital plasma improves survival in severely injured patients transported by air ambulance. We hypothesized that prehospital plasma would be associated with a reduction in immune imbalance and endothelial damage. METHODS. We sampled blood from 405 trauma patients enrolled in the Prehospital Air Medical Plasma (PAMPer) trial upon hospital admission (0 hours) and 24 hours post admission across 6 U.S. sites. We assayed samples for 21 inflammatory mediators and 7 markers associated with endothelial function and damage. We performed hierarchical clustering analysis (HCA) of these biomarkers of the immune response and endothelial injury. Regression analysis was used to control for differences across study and to assess any association with prehospital plasma resuscitation. RESULTS. HCA distinguished two patient clusters with different injury patterns and outcomes. Patients in cluster A had greater injury severity and incidence of blunt trauma, traumatic brain injury, and mortality. Cluster A patients that received prehospital plasma showed improved 30-day survival. Prehospital plasma did not improve survival in cluster B patients. In an adjusted analysis of the most seriously injured patients, prehospital plasma was associated with an increase in adiponectin, IL-1β, IL-17A, IL-23, and IL-17E upon admission, and a reduction in syndecan-1, TM, VEGF, IL-6, IP-10, MCP-1, and TNF-α, and an increase in IL-33, IL-21, IL-23, and IL-17E 24 hours later. CONCLUSION. Prehospital plasma may ameliorate immune dysfunction and the endotheliopathy of trauma. These effects of plasma may contribute to improved survival in injured patients.
UR - http://www.scopus.com/inward/record.url?scp=85084027418&partnerID=8YFLogxK
U2 - 10.1172/jci.insight.135350
DO - 10.1172/jci.insight.135350
M3 - Article
C2 - 32229722
AN - SCOPUS:85084027418
SN - 2379-3708
VL - 5
JO - JCI Insight
JF - JCI Insight
IS - 8
M1 - e135350
ER -