Reperfusion injury or cytokine storm? Utilizing plasmapheresis in severe trauma-induced multiorgan failure: a case report.

Journal of Trauma and Injury Pub Date : 2024-12-01 Epub Date: 2024-12-04 DOI:10.20408/jti.2024.0051
Gun Woo Kim, Suyeong Hwang, Kyoung Hoon Lim, Sung Hoon Cho
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Abstract

Reperfusion injury can cause tissue damage due to ischemia, with severe cases potentially resulting in multiorgan failure. Cytokine storm, a life-threatening systemic inflammatory state characterized by elevated levels of circulating cytokines and hyperactive immune cells, can also lead to tissue damage and multiorgan failure. Reperfusion injury and cytokine storm sometimes exhibit similar clinical features, necessitating specific treatment in severe cases. A 31-year-old man sustained a stab wound to his left knee. Computed tomography angiography and surgical exploration revealed a transection of the left popliteal artery and vein. Both vessels were revascularized via end-to-end anastomosis approximately 3 hours after the injury. On postoperative day 2, marked increases were observed in levels of aspartate aminotransferase (8,600 U/L), alanine transaminase (6,690 U/L), creatine phosphokinase (26,817 U/L), and lactate dehydrogenase (7,398 U/L) levels. Elevated levels of interleukin 6 (178 pg/mL) and ferritin (41,079 ng/mL) were also noted. Given the possibility of either reperfusion injury or cytokine storm, plasmapheresis was initiated. Following two rounds of plasmapheresis, the patient's condition rapidly improved, and he was discharged without complications. Reperfusion injury can arise when a target blood vessel is revascularized, particularly during severe stages of ischemia. Cytokine storm represents a life-threatening systemic inflammatory state characterized by high levels of circulating cytokines and overactive immune cells. Both reperfusion injury and cytokine storm can cause systemic inflammation and multiorgan failure. These two conditions may exhibit similar clinical features, necessitating supportive care primarily to prevent organ dysfunction. However, plasmapheresis may represent an effective treatment option in cases of severe progression.

再灌注损伤还是细胞因子风暴?血浆置换术治疗严重外伤性多器官功能衰竭1例。
再灌注损伤可因缺血引起组织损伤,严重者可导致多器官衰竭。细胞因子风暴是一种危及生命的系统性炎症状态,其特征是循环细胞因子水平升高和免疫细胞过度活跃,也可导致组织损伤和多器官衰竭。再灌注损伤和细胞因子风暴有时表现出相似的临床特征,严重者需要特异性治疗。一名31岁男子左膝被刺伤。计算机断层血管造影和手术探查显示左腘动脉和静脉横断。两根血管在损伤后约3小时通过端到端吻合术重建血运。术后第2天,观察到天冬氨酸转氨酶(8,600 U/L)、丙氨酸转氨酶(6,690 U/L)、肌酸磷酸激酶(26,817 U/L)和乳酸脱氢酶(7,398 U/L)水平显著升高。白细胞介素6 (178 pg/mL)和铁蛋白(41,079 ng/mL)的水平也有所升高。考虑到再灌注损伤或细胞因子风暴的可能性,血浆置换开始。经过两轮血浆置换后,患者病情迅速好转,出院时无并发症。再灌注损伤可在靶血管重建时发生,特别是在缺血严重阶段。细胞因子风暴是一种危及生命的系统性炎症状态,其特征是高水平的循环细胞因子和过度活跃的免疫细胞。再灌注损伤和细胞因子风暴均可引起全身炎症和多器官功能衰竭。这两种情况可能表现出相似的临床特征,需要支持性护理,主要是为了防止器官功能障碍。然而,血浆置换可能是严重进展情况下的有效治疗选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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