Clinical application of a novel diagnostic scheme including pancreatic β‑cell dysfunction for traumatic multiple organ dysfunction syndrome

Wang,Zhan‑Ke; Chen,Rong‑Jian; Wang,Shi‑Liang; Li,Guang‑Wei; Zhu,Zhong‑Zhen; Huang,Qiang; Chen,Zi‑Li; Chen,Fan‑Chang; Deng,Lei; Lan,Xiao‑Peng; Hu,Tian

doi:10.3892/mmr.2017.7898

Clinical application of a novel diagnostic scheme including pancreatic β‑cell dysfunction for traumatic multiple organ dysfunction syndrome

Authors:
- Zhan‑Ke Wang
- Rong‑Jian Chen
- Shi‑Liang Wang
- Guang‑Wei Li
- Zhong‑Zhen Zhu
- Qiang Huang
- Zi‑Li Chen
- Fan‑Chang Chen
- Lei Deng
- Xiao‑Peng Lan
- Tian Hu
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Affiliations: Department of Clinical Laboratory, The 94th Hospital of People's Liberation Army, Nanchang, Jiangxi 330002, P.R. China, Department of General Surgery, The 94th Hospital of People's Liberation Army, Nanchang, Jiangxi 330002, P.R. China, Department of Burns, Third Military Medical University, Chongqing 400038, P.R. China, Department of Endocrinology, China‑Japan Friendship Hospital, Beijing 100029, P.R. China, Trauma Emergency Center, The 94th Hospital of People's Liberation Army, Nanchang, Jiangxi 330002, P.R. China, Department of Intensive Medicine, The 94th Hospital of People's Liberation Army, Nanchang, Jiangxi 330002, P.R. China, Department of Neurosurgery, The 94th Hospital of People's Liberation Army, Nanchang, Jiangxi 330002, P.R. China, Department of Clinical Laboratory, Fuzhou General Hospital of Nanjing Military Region, Fuzhou, Fujian 350025, P.R. China, Department of Wound Healing and Cell Biology Laboratory, Institute of Basic Medical Science, Trauma Centre of Postgraduate Medical School, Chinese People's Liberation Army General Hospital, Beijing 100853 P.R. China
Published online on: October 26, 2017 https://doi.org/10.3892/mmr.2017.7898
Pages: 683-693

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Abstract

A novel diagnostic scheme that includes pancreatic β‑cell dysfunction analysis for the diagnosis of traumatic multiple organ dysfunction syndrome (MODS) was investigated to assist in the early diagnosis and detection of MODS. Early intervention and treatment of MODS has been associated with a reduced mortality rate. A total of 2,876 trauma patients (including patients post‑major surgery) were admitted to the intensive care unit of the authors' hospital between December 2010 and December 2015 and enrolled in the present study. There were 205 cases where the patient succumbed to their injuries. In addition to the conventional diagnostic scheme for traumatic MODS, indexes of pancreatic β‑cell dysfunction [fasting blood‑glucose (FBG), homeostatic model assessment‑β and (blood insulin concentration 30 min following glucose loading‑fasting insulin concentration)/(blood glucose concentration 30 min following glucose loading‑FBG concentration)] were included to establish an improved diagnostic scheme for traumatic MODS. The novel scheme was subsequently used in clinical practice alongside the conventional scheme and its effect was evaluated. The novel scheme had a significantly higher positive number of MODS diagnoses for all trauma patients compared with the conventional scheme (12.48 vs. 8.87%; P<0.01). No significant difference was identified in the final percentage of positive of MODS diagnoses for trauma‑associated mortality patients between the novel (88.30%) and the conventional scheme (86.34%). The novel scheme had a significantly higher positive number of MODS diagnoses for trauma‑associated mortality patients 3 days prior to patients succumbing to MODS compared with the conventional scheme (80.98 vs. 64.39%; P<0.01). The consensus of the MODS diagnosis of all trauma patients between the novel scheme and the conventional scheme was 100%; however, out of the patients diagnosed as positive by novel scheme 71.03% were positive by the conventional scheme. The consensus between the final MODS diagnosis and the MODS diagnosis 3 days prior to patients succumbing to their injuries between the novel scheme and the conventional scheme was 100%; however, out of the patients diagnosed as positive by novel scheme 97.79 were positive by the conventional scheme of the 205 patients who succumbed to MODS and out of the patients diagnosed as positive for MODS by novel scheme 3 days prior to succumbing, 79.52% were positive by the conventional scheme. The results of the present study demonstrated that the novel diagnostic scheme using the relevant indexes of pancreatic β‑cell dysfunction for diagnosis of traumatic MODS, was able to diagnose MODS early without excessively extending the diagnostic scope. Its clinical application should be promoted.

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