THE NOVEL MARKER OF REACTIVE HEPATITIS IN INJURED WITH GUNSHOT WOUNDS

  • G. V. Osodlo Ukrainian Military Medical Academy of the Ministry of Defense of Ukraine, Kyiv, Ukraine
  • K. V. Savichan Ukrainian Military Medical Academy of the Ministry of Defense of Ukraine, Kyiv, Ukraine
Keywords: gunshot wounds, reactive hepatitis, servicemen, transaminase concentration, albumin concentration, coefficient of reactive hepatitis of the injured

Abstract

Objective. The aim of the study was to improve the diagnosis of reactive hepatitis in injured with gunshot wounds.

Methods. A retrospective analysis of 373 medical histories of servicemen wounded during the war in eastern Ukraine in 2014-2020, 233 of whom were hospitalized at the National Military Medical Clinical Center (NMMCC) and military medical clinical centres of the North, South, Eastern regions of the Ministry of Defense of Ukraine for more than 14 days. All servicemen had laboratory examinations using unified methods of laboratory tests. The obtained data were processed using non-parametric statistical methods.

Results. The median baseline of ALT and, to a greater extent, AST (in the first period of traumatic illness) exceeds the upper limit of normal (40 IU / l). The highest values ​​of ALT were observed in the second period of traumatic illness on the 5th and 10th day of observation with a slight decrease in the next stage of the study. The concentration of AST increased significantly in the first period of traumatic illness, almost did not decrease in the second period, but approached normal values ​​≥14 days after injury. The strongest correlation between transaminases and albumin levels was found. A new calculated indicator in the form of the ratio of ALT concentration to albumin concentration (coefficient of reactive hepatitis of the injured, CRGI) is proposed. The development of post-traumatic reactive hepatitis was confirmed in all cases with the wounded with the value of CRGI ≥2.0.

Conclusions.

1. Based on a retrospective analysis of 373 case histories of wounded in different periods after a gunshot wound, a new calculated indicator is proposed - the coefficient of reactive hepatitis of the injured (CRGI) in the form of the ratio of ALT/albumin concentrations, the increase of which indicates hepatocellular damage of hepatocytes with simultaneous suppression of the protein-synthetic function of the liver on the background of catabolic reactions.

2. CRGI ≥2 indicates the development of reactive hepatitis, is most often observed in the second period of traumatic illness and tends to normalize in the background of effective treatment. In the wounded who died as a result of injuries, CRGI steadily increased and was significantly higher than in the wounded with the uncomplicated course, especially in the third period of traumatic illness - after 14 days or more (4.0 vs. 2.3, respectively), which indicates the possible use of the proposed indicator as a prognostic criterion for worsening the prognosis in the wounded.

References

Bilyi VIa, Zhakhovskyi VO, Livinskyi VH. Mistse ta rol Voienno-medychnoi doktryny Ukrainy u formuvanni systemy medychnoho zabezpechennia viisk i tsyvilnoho naselennia u voiennyi chas [The place and role of the Military Medical Doctrine of Ukraine in the formation of the system of medical support of troops and civilians in wartime]. Nauka i oborona. 2015; 1: 9-14. [Ukrainian]

Osyodlo GV, editor. Voienno-polova terapiia : pidruchnyk [Military-field therapy: handbook]. Second edition. K.: SPD Chalchynska N.V., 2022. 646 p. [Ukrainian]

Kazmirchuk AP, Miasnykov HV, Sydorova LL, Sydorova NN. Predvarytelnue rezultatu analyza ystoryi bolezny postradavshykh v zone provedenyia antyterrorystycheskoi operatsyy [Preliminary results of the analysis of case histories of injured in the zone of the anti-terrorist operation]. Current aspects of military medicine: a collection of scientific works of the Main Military Medical Clinical Center "GVKG" of the Ministry of Defense of Ukraine. 2015; 22(1): 39-44. [Russian]

Kochin IV. Osoblyvosti medyko-sanitarnykh vtrat i orhanizatsii ekstrenoi medychnoi dopomohy naselenniu ta viiskovosluzhbovtsiam v zoni provedennia antyterorystychnoi operatsii [Features of medical casualties and organization of emergency medical care for the population and servicemen in the area of the anti-terrorist operation]. Emergency medicine. 2015; 6 (69): 44-51. [Ukrainian]

Savichan KV, Osyodlo HV, Bychkova SA, Ivanova AIu, inventors; Savichan KV assignee. Sposib diahnostyky reaktyvnoho hepatytu u poranenykh vohnepalnoiu zbroieiu [A method for diagnosing reactive hepatitis in wounded by firearms]. Ukraine patent application a 2022 00859. 2022 Feb 23. [Ukrainian]

Stepanov YuM, editor. Suchasni metody doslidzhennia v hastroenterolohii [Modern research methods in gastroenterology] K.: Vydavets Zaslavskyi OIu, 2019. 152 p. [Ukrainian].

Shevchuk VI, Beliaieva NM, Yavorovenko OB, Kurylenko IV, Haliutyna OIu. Sotsialni naslidky urazhen vnutrishnikh orhaniv v uchasnykiv antyterorystychnoi operatsii [Social consequences of damage to internal organs in participants in the anti-terrorist operation]. Zbirnyk naukovykh prats spivrobitnykiv NMAPO imeni P.L.Shupyka. 2016; 25: 77-83. [Ukrainian]. Available from: http://nbuv.gov.ua/UJRN/Znpsnmapo_2016_25_13

Botros M, Sikaris KA. The De Ritis ratio: the test of time. Clin Biochem Rev. 2013;34(3):117-30. Available on: https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC3866949

Hinojosa-Laborde C, Shade RE, Frost PA, Dutton JW, Muniz GW, Hudson IL, et al. Indices of muscle and liver dysfunction after surviving hemorrhage and prolonged hypotension. J Trauma Acute Care Surg. 2019 Jul;87(1S Suppl 1):S101-S109. doi: 10.1097/TA.0000000000002311

Koyama T, Hamada H, Nishida M, Naess PA, Gaarder C, Sakamoto T. Defining the optimal cut-off values for liver enzymes in diagnosing blunt liver injury. BMC Res Notes. 2016 Jan 25;9:41. doi: 10.1186/s13104-016-1863-3

Lescot T, Karvellas C, Beaussier M, Magder S, Riou B. Acquired Liver Injury in the Intensive Care Unit. Anesthesiology. 2012; 117: 898–904. https://doi.org/10.1097/ALN.0b013e318266c6df

Newsome PN, Cramb R, Davison SM, Dillon JF, Foulerton M, Godfrey EM et al. Guidelines on the management of abnormal liver blood tests. Gut. 2018; 67: 6–19. doi:10.1136/gutjnl-2017-314924

Relja B, Yang B, Bundkirchen K, Xu B, Köhler K, Neunaber C. Different experimental multiple trauma models induce comparable inflammation and organ injury. Sci Rep. 2020; 10: 20185. doi: 10.1038/s41598-020-76499-z

de Ritis F, Giusti G, Coltorti M. Serum phosphoglucomutase activity in human virus hepatitis. Experientia. 1957; 13(2): 81-82. doi: 10.1007/BF02160104.

Shepherd JM, Cole E, Brohi K. Contemporary patterns of multiple organ dysfunction in trauma. Shock. 2017 Apr;47(4):429-435. doi: 10.1097/SHK.0000000000000779

Suciu A, Abenavoli L, Pellicano R, Luzza F, Dumitrascu DL. Transaminases: oldies but goldies. A narrative review. Minerva Gastroenterol Dietol. 2020 Sep;66(3):246-251. doi: 10.23736/S1121-421X.20.02660-4. Epub 2020 Jan 28. PMID: 31994373.

Published
2022-06-10
How to Cite
Osodlo, G. V., & Savichan, K. V. (2022). THE NOVEL MARKER OF REACTIVE HEPATITIS IN INJURED WITH GUNSHOT WOUNDS. Modern Medical Technology, (2(53), 49-54. https://doi.org/10.34287/MMT.2(53).2022.10
Section
Original research