The Utility of Ubiquitin Carboxyl-Terminal Hydrolase L1 as a Marker of Hemorrhagic Shock.

INTRODUCTION

Ubiquitin carboxyl-terminal hydrolase L1 (UCHL1) is used as a biomarker of traumatic brain injury (TBI). However, there is limited data on the use in critically injured or polytrauma patients. In this study, we hypothesized that UCHL1 may also serve as a marker of shock and global hypoperfusion after critical injury.

METHODS

Serum samples were collected from 425 intensive care unit-admitted trauma patients. Samples were retrospectively analyzed for UCHL1 by enzyme-linked immunosorbent assay. Supplementary data were collected from medical record review, including TBI and blood transfusion requirement used as a surrogate for hemorrhagic shock.

RESULTS

UCHL1 level was associated with TBI diagnosis at arrival (P = 0.02) but not at 24 or 72 h. UCLH1 was also significantly elevated at higher level transfusion at 24 (rho = 0.21) and 72 (rho = 0.19) h (P < 0.001). In addition, UCHL1 was significantly elevated in the 30-d mortality group at 0, 24, and 72 h (P < 0.04). When compared to lactic acid, a current standard marker of shock and resuscitation, mean lactic acid demonstrated similar associations with elevations at higher level transfusion at 0 (rho = 0.38), 6 (rho = 0.19), and 24 (rho = 0.25) h (P < 0.002). In addition, lactic acid was also elevated in the 30-d mortality group at all time points (P < 0.04).

CONCLUSIONS

In critical injury, UCHL1 levels are elevated in both TBI and hemorrhagic shock. Therefore, after severe injury, UCHL1 may also serve as an indicator of global hypoperfusion. The associations of UCHL1 with shock and 30-d mortality could be applied to rapid bedside detection of shock and assessment of resuscitation progression.