Background: Products of the hemeoxygenase enzyme include carboxyhemoglobin
(COH) and bilirubin, which have protective effects in stressed states, Heme
oxygenase-1 enzyme up-regulates in states of oxidative stress. We hypothesi
zed that COB is elevated in septic trauma patients compared with nonseptic
patients,
Methods: A prospective study was carried out at a Level I trauma center inv
olving all patients admitted to the trauma intensive care unit. During a 3.
5-month period, 45 patients were enrolled, with 76 samples being drawn on a
dmission and at later time points. The samples were classified as septic (B
one's criteria), stressed (based on expired gas analysis), or nonstressed n
onseptic, Correlations with Acute Physiology and Chronic Health Evaluation
III score, white blood cell count, temperature, partial pressure of oxygen,
and percentage of inspired oxygen were evaluated.
Results: COR levels in samples drawn from patients presenting in shock (sys
tolic blood pressure less than or equal to 90 mm Hg) were significantly hig
her than levels in samples from patients not in shock (systolic blood press
ure > 90 mm Hg) (3.27 +/- 1.09 vs. 2.75 +/- 0.64; p = 0,013), Samples from
septic patients with infection were associated with significantly higher In
jury Severity Scares (34.1 +/- 11.2 vs. 21.8 +/- 18.3; p less than or equal
to 0.05) and a lower percentage of inspired oxygen (41.6 +/- 10.3 vs. 61.0
+/- 26.3; p less than or equal to 0,05),
Conclusion: COH was significantly elevated in samples drawn during stress,
sepsis, and shock states. There was overlap between sepsis and stress COH s
ample values, limiting the clinical usefulness of the assays in predicting
sepsis, Further studies focusing on hemeoxygenase-1 expression and the role
of its by-products in the outcomes of trauma patients are-warranted.