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Urinary Biomarkers are Associated with Severity and Mechanism of Injury

Janak, Jud C.; Stewart, Ian J.; Sosnov, Jonathan A.; Howard, Jeffrey T.; Siew, Edward D.; Chan, Mallory M.; Wickersham, Nancy; Ikizler, T. Alp; Chung, Kevin K.

doi: 10.1097/SHK.0000000000000784
Clinical Aspects
Editor's Choice

ABSTRACT: Combat-related blast trauma results in massive tissue injury and tends to involve multiple systems. Further, an acute measure of injury severity based on underlying biological mechanisms may be important for the triage and treatment of these types of patients. We hypothesized that urinary biomarkers (UBs) would reflect severity of injury and that they would be elevated for blast injuries compared with gunshot wounds (GSW) in a cohort of combat casualties. We also postulated that UBs would be higher in patients with burns compared with patients with non-burn trauma in a civilian cohort. Among 80 service members who sustained combat-related injuries, we performed generalized estimating equations to compare differences in log-transformed concentrations of the UBs by both injury severity and injury mechanism. Among 22 civilian patients, we performed Kruskal–Wallis tests to compare differences for the UBs stratified by burn and non-burn trauma. In the military cohort, with the exception of IL-18, all UBs were significantly (P <0.05) higher for patients with a severe combat-related injury (Injury Severity Score ≥25). In addition, all crude UBs concentrations were significantly higher for blast versus GSW patients (P < 0.05). After adjusting for injury severity score and time of UB draw, KIM-1 (2.80 vs. 2.31; P = 0.03) and LFABP (−1.11 vs. −1.92; P = 0.02) were significantly higher for patients with a blast mechanism of injury. There were no significant differences in UBs between burn and non-burn civilian trauma patients. Future studies are needed to understand the physiologic response to trauma and the extent that UBs reflect these underlying processes.

*United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas

Clinical Investigation Facility, David Grant Medical Center, Travis AFB, California

Uniformed Services University of the Health Sciences, Bethesda, Maryland

§San Antonio Military Medical Center, JBSA Fort Sam Houston, Texas

||Vanderbilt University Medical Center, Nashville, Tennessee

Address reprint requests to Ian J. Stewart, MD, USAF, MC, 101 Bodin Circle, Travis AFB, CA 94535. E-mail:

Received 12 June, 2016

Revised 5 July, 2016

Accepted 21 October, 2016

The views expressed herein are those of the authors and do not reflect the official policy or position of Brooke Army Medical Center, the US Army Medical Department, the US Army Office of the Surgeon General, the Department of the Army the Department of the Air Force, the Department of Defense, or the US Government.

All of the authors have met one or more of the International Committee of Medical Journal Editors criteria for authorship.

Dr EDS reports a consultancy with Alere. The study was funded by a grant from the Air Force Medical Support Agency and by an appointment to the Internship/Research Participation Program at the United States Army Institute of Surgical Research (USAISR), administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the US Department of Energy and EPA. Additional funding was also provided by the Clinical Trials Task Area, USAISR.

The authors report no conflicts of interest.

© 2017 by the Shock Society