Andrew Lumley1, Erik Osborn2, Adrian Mellor3, Elise LaCroix4, George Johnson2, Mary Wallace5, Mike Stacey6, Jason E Smith7, David Woods8. 1. 335 Medical Evacuation Regiment, Queen Elizabeth Barracks, York, UK; East Anglian Air Ambulance, Norwich, UK. Electronic address: andrewlumley@nhs.net. 2. Tripler Army Medical Centre, Honolulu, HI, USA. 3. James Cook University Hospital, Middlesbrough, UK; Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine (Research & Academia), Birmingham, UK; Carnegie Faculty, Leeds Beckett University, Leeds, UK. 4. Landstuhl Regional Medical Center, Landstuhl, Germany. 5. San Antonio Military Medical Center, San Antonio, TX, USA. 6. Academic Department of Military Medicine, Royal Centre for Defence Medicine (Research & Academia), Birmingham, UK. 7. Emergency Department, Derriford Hospital, Plymouth, UK; Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Birmingham, UK. 8. Academic Department of Military Medicine, Royal Centre for Defence Medicine (Research & Academia), Birmingham, UK; Carnegie Faculty, Leeds Beckett University, Leeds, UK.
Abstract
PURPOSE: To study the relationship between serum neutrophil gelatinase-associated lipocalin (NGAL) and military blast and gunshot wound (GSW) to establish whether potential exists for NGAL as a biomarker for blast lung injury (BLI). METHOD: Patients from the intensive care unit (ICU) of the Role 3 Medical Treatment Facility at Camp Bastion, Helmand Province, Afghanistan were studied over a five month period commencing in 2012. Age, mechanism, trauma injury severity score (TRISS) and serum NGAL were recorded on ICU admission (NGAL1). Serum NGAL (NGAL2) and PaO2/FiO2 ratio (P/F ratio2) were recorded at 24h. RESULTS: 33 patients were injured by blast and 23 by GSW. NGAL1 inversely correlated with TRISS (p=0.020), pH (p=0.002) and P/F ratio 2 (p=0.009) overall. When data was stratified into blast and GSW, NGAL1 also inversely correlated with P/F ratio 2 in the blast injured group (p=0.008) but not GSW group (p=0.27). CONCLUSION: Raised NGAL correlated with increased severity of injury (worse survival probability i.e. TRISS and low pH) in both patient groups. There was an inverse correlation between admission NGAL and a marker of blast lung injury (low P/F ratio) at 24h in blast injured group but not GSW group that warrants further investigation.
PURPOSE: To study the relationship between serum neutrophil gelatinase-associated lipocalin (NGAL) and military blast and gunshot wound (GSW) to establish whether potential exists for NGAL as a biomarker for blast lung injury (BLI). METHOD:Patients from the intensive care unit (ICU) of the Role 3 Medical Treatment Facility at Camp Bastion, Helmand Province, Afghanistan were studied over a five month period commencing in 2012. Age, mechanism, trauma injury severity score (TRISS) and serum NGAL were recorded on ICU admission (NGAL1). Serum NGAL (NGAL2) and PaO2/FiO2 ratio (P/F ratio2) were recorded at 24h. RESULTS: 33 patients were injured by blast and 23 by GSW. NGAL1 inversely correlated with TRISS (p=0.020), pH (p=0.002) and P/F ratio 2 (p=0.009) overall. When data was stratified into blast and GSW, NGAL1 also inversely correlated with P/F ratio 2 in the blast injured group (p=0.008) but not GSW group (p=0.27). CONCLUSION: Raised NGAL correlated with increased severity of injury (worse survival probability i.e. TRISS and low pH) in both patient groups. There was an inverse correlation between admission NGAL and a marker of blast lung injury (low P/F ratio) at 24h in blast injured group but not GSW group that warrants further investigation.