Background: In low concentrations, lipopolysaccharide-binding protein (LBP), an acute-phase
protein recognizing lipopolysaccharide (LPS), catalyzes its transfer to the cellular receptor
consisting of CD14 and Toll-like receptor-4. Previous studies have documented increased
serum LBP concentrations in patients with sepsis, systemic inflammatory response syndrome
(SIRS), or acute pancreatitis and after cardiopulmonary bypass. No prior studies have examined
LBP expression in trauma victims. We hypothesized that admission LBP plasma concentrations
are predictive of outcome (mortality) in trauma. This study assessed time-dependent
changes in serum LBP concentrations in trauma patients soon after injury.
Methods: A prospective, single-institution, observational cohort study of 121 adult trauma
patients (age ≥17 years) with moderate to severe injury who required hospitalization. The
trauma patients were male in 79.6% of the cases and had a mean age of 43.0 ± 20.6 years. The
mean injury severity score (ISS) was 23 ± 12, and the crystalloid resuscitation volume given
in the first 24 h averaged 6,640 ± 3,729 mL. Informed consent was obtained on admission, and
blood samples were drawn on admission and at 24 h postadmission. Prospective data were
collected for daily SIRS score, multiple organ dysfunction score (MODS), and sequential organ
failure assessment (SOFA) score, complications, and outcomes. Plasma concentrations of
LBP were measured by enzyme-linked immunosorbent assay.
Results: Sixty patients (48.8% of the study cohort) required emergency surgical intervention
and sustained a substantial intraoperative blood loss (mean 1,404 ± 2,757 mL). The hospital
mortality rate was 16.3% (20 patients). The mean intensive care unit stay was 8.9 ± 16.4
days, and the hospital stay was 14.8 ± 19.6 days. The patients had a significantly higher serum
concentrations of LBP on admission (mean 28.0 ± 25.3 mg/L; range 2–100 mg/L) than did control
subjects (mean 6.2 ± 2.1 mg/L; range 1.3–12.8 mg/L; p < 0.01), similar to the plasma concentrations
previously reported in septic patients. A significant increase in LBP concentration
was noted at 24 h (mean 72.3 ± 45.7 mg/L; range 8–210 mg/L; p < 0.05). The admission LBP
concentration was significantly greater in nonsurvivors than in survivors. However, after controlling
for age and ISS, the admission LBP concentration did not predict death.
