Ricerc@Sapienza

Trauma is the most common cause of death in young adults and it is the third most common cause of death at all ages with liver being the most commonly blunt injured abdominal organ. In the present study we will analyze the role of HMGB1, NALP3, IL-1beta, IL-6, TNF-alpha and serum electrolytes in predicting the severity of blunt liver trauma according to the Injury Severity Score (ISS), and the American Association for the Surgery of Trauma for liver Trauma (AAST) and the potential prognostic value for morbidity, mortality and length of stay. Our study will be conducted at the Policlinico Umberto I and San Giovanni-Addolorata. All consecutive patients emergently admitted in the next 12 months for blunt liver trauma will be selected after the exclusion of patients who eventually will die in the emergency room before any type of treatment. We estimate to include at least 50 patients. Demographics, cause and mechanism of injury, hematochemical tests, HMBG1, NALP3, IL-1, IL-6 and TNF-a plasma levels at admittance and thereafter every 8 hours for the next 48 hours, serum electrolytes (Na+, Cl-, K+) values, associated injuries and computed tomography (CT) scan findings at admission will be evaluated.The patients will undergo three different types of treatment: 1-non-operative management, 2-interventional radiologic treatment, 3-operative management (peri-hepatic packing, hepatotomy and selective vascular suture or ligation and anatomical or nonanatomical hepatic resection). All patients who will undergo to an open surgical treatment will be harvested a segment of the damaged and not vital liver 2x2 cm for further biologic analysis. Three different levels of biological analyses will be performed to evaluate the influence and prognostic values of the cytokines, HMBG1and NALP3: 1-plasma level concentration with ELISA technique; 2-Western blot and RT-PCR from the hepatic cell to quantitatively calculated the RNA expression.