Laboratory markers of inflammatory activity in patients with combat limb injuries

The study aim – to investigate laboratory markers of inflammatory activity (C-reactive protein, ESR, leukocytes and leukocyte indices, interleukin-6 and ferritin) in patients with combat limb injuries. Materials and methods. The prospective observational study enrolled 248 patients who suffered from combat injuries of the lower and/or upper extremities in the period from 4 to 58 days (mean 15.8±8.6 days) before admission to the hospital. All study participants were men. The age of the study patients ranged from 19 to 59 years, with a mean of 35.6±8.3 years. Most often, wounds were localized on the legs (29.3% of cases) and feet (12.8%). In all patients, the level of C-reactive protein (CRP) was determined, general and biochemical blood tests were performed, and the ratio of neutrophils to lymphocytes (NLR), neutrophils to monocytes (NMR), platelets to lymphocytes (PLR), and lymphocytes to monocytes (LMR) was calculated, as well as the systemic immunoinflammatory index (SII). The ratio of CRP to albumin was calculated. In 62 patients the concentration of interleukin-6 (IL-6) and in 42 patients the level of ferritin in the blood were determined. Results. The mean value of CRP was 43.6 mg/l, ESR – 44.5 mm/h, leukocyte count – 9.7×109/l, neutrophil count – 6.8×109/l, platelets – 514.7×109/l, NLO – 4, 47, NMO – 9.29, LMO – 2.49, TLO – 323.2. The median of the systemic immuno-inflammatory index was 1089. The level of CRP was increased in 87.1% of patients, ESR – in 87.3%. Leukocytosis was detected in 52.2% of the wounded, thrombocytosis – in 83.1%. The median concentration of IL-6 was 0.86 pg/ml, ferritin – 249.1 ng/ml, CRP to albumin ratio – 0.61. In patients with amputated limbs, significantly higher levels of CRP (p=0.0005), leukocyte count (p=0.00007, neutrophil count (p=0.000004), % of neutrophils (p=0.000009), NLO (p=0.000002), SII (p=0.0003) and IL-6 (p=0.02) were registered. In patients with thrombosis, higher levels of IL-6 (p=0.02), leukocyte count (p=0.006), number of neutrophils (p=0.002), % of neutrophils (p=0.01), greater NLO (p=0.001) and SII (p=0.01) were observed. Inverse correlations were established between the time elapsed from the moment of injury and various laboratory parameters: CRP (p<0.000001), ESR (p=0.0001), number of leukocytes (p<0.000001) and neutrophils (p<0.000001), NLO (p<0.000001), SII (p=0.002), fibrinogen (p=0.000002) and the ratio of CRP to albumin (p=0.000002). Highly significant correlations were recorded between various laboratory indicators of inflammatory activity. Direct correlations were established between the investigated laboratory indicators of inflammatory activity and the number of surgical treatments of wounds. Conclusion: The study results demonstrate a significant increase in all investigated laboratory parameters of inflammation in patients with combat injuries. Continued research is needed to investigate laboratory markers of inflammatory activity in patients with combat wounds.