A conceptual time window‐based model for the early stratification of trauma patients
Autor: | Ashley J. Lamparello, Greg Constantine, Rajaie Namas, Timothy R. Billiar, Eric A. Elster, Yoram Vodovotz, Todd O. McKinley |
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Rok vydání: | 2019 |
Předmět: |
0301 basic medicine
Prognostic variable medicine.medical_specialty Time Factors Adverse outcomes 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Time windows Internal Medicine Humans Medicine Intensive care medicine Clinical Trials as Topic business.industry Cell injury Models Theoretical Prognosis medicine.disease Polytrauma Circulating biomarkers 030104 developmental biology Wounds and Injuries business Patient stratification Biomarkers |
Zdroj: | Journal of Internal Medicine. 286:2-15 |
ISSN: | 1365-2796 0954-6820 |
Popis: | Progress in the testing of therapies targeting the immune response following trauma, a leading cause of morbidity and mortality worldwide, has been slow. We propose that the design of interventional trials in trauma would benefit from a scheme or platform that could support the identification and implementation of prognostic strategies for patient stratification. Here, we propose a stratification scheme based on defined time periods or windows following the traumatic event. This 'time-window' model allows for the incorporation of prognostic variables ranging from circulating biomarkers and clinical data to patient-specific information such as gene variants to predict adverse short- or long-term outcomes. A number of circulating biomarkers, including cell injury markers and damage-associated molecular patterns (DAMPs), and inflammatory mediators have been shown to correlate with adverse outcomes after trauma. Likewise, several single nucleotide polymorphisms (SNPs) associate with complications or death in trauma patients. This review summarizes the status of our understanding of the prognostic value of these classes of variables in predicting outcomes in trauma patients. Strategies for the incorporation of these prognostic variables into schemes designed to stratify trauma patients, such as our time-window model, are also discussed. |
Databáze: | OpenAIRE |
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