الفهرس 
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Abstract
The present study was conducted on 150 patients with polytrauma (134 males and 16 females aged from 20 to 60 years). They were recruited from Emergency Hospital Mansoura University in the ýperiod from April 2006 to October 2006. Those patients characterized by injury of more than one body system. Careful history taking and complete clinical examination were done to all cases. The patients were assessed for trauma severity by injury severity score (ISS), the patients were grouped with respect to injury severity: LRG = ISS ? 31, HRG = ISS > 31. All cases included in the study were followed up to 7 days for, SIRS, sepsis, MODS, surgery and survival. Routine trauma laboratory panel and special thesis protocol ýinvestigations (CPK, lactate, MDA and procalcitonin) were estimated from blood samples obtained at ýadmission, at 3rd day and at 7th day. The study of groups showed that ISS, incidence of surgical ýinterference and incidence of complications (sepsis, SIRS, MODS and non survival) were statistically ýsignificant higher in HRG in comparison to LRG. The median value of serum CPK levels were significantly ýhigh in HRG, septic, SIRS, MODS, surgical interference and non survival groups in comparison to the ýcorresponding groups respectively on admission, on 3rd day and on 7th day. In all groups the followed up ýserum levels of CPK showed significant decrease at 3rd and 7th days in comparison to admission levels ýand in 7th day in comparison to 3rd day. The curve was decreased allover the study period. There are ýpositive significant correlations between CPK and MDA and ISS and SIRS and sepsis and positive ýsignificant correlation with non survival. The median values of serum lactate were significantly high in ýHRG, septic, MODS, surgical interference, non survival and SIRS in comparison to the corresponding ýgroups on admission, on 3rd day and on 7th day. In all groups the followed up serum lactate levels were ýsignificant decreased in 7th and 3rd days in comparison to admission level, it were significantly low in 7th ýday in comparison to 3rd day, the curves were decreased allover the study period. Serum lactate levels ýShowed highest sensitivity and specificity in septic group on admission and 3rd day and it showed positive ýsignificant correlations between lactate concentration and MDA, PCT, ISS, sepsis, surgical interference and ýpositive significant correlation with non survival. The median value of serum MDA was significantly high ýin HRG in comparison to LRG on admission, on 3rd day and on 7th day. In the present study, the ýoccurrence of more MDA in the high risk group than in the low risk group (significant ) might be related to ýlarger mass of injured tissues, ischemia / reperfusion injury and to (significant) higher incidence of surgical ýinterference, sepsis, and MOD syndrome in the HRG patients. The high values of serum MDA ýconcentrations on the 3rd day can be attributed to the occurrence of sepsis and surgical interference in ýsome patients. The median value of serum MDA levels were significantly high in septic, MODS, surgical ýinterference and SIRS group in comparison to non septic, non MODS, non surgical interference and non ýsurgical interference group on admission, on 3rd day and on 7th day. The values of serum MDA ýconcentrations in patients who were subjected to surgical interference coincided with the exposure of these ýpatients to a 2nd trauma (operative trauma) with further tissue damage and oxidative stress. The median ývalue is insignificantly high in non survivors versus survivors group on admission, on 3rd day and on 7th ýday. The median values of plasma PCT levels were significantly high in HRG in comparison to LRG on admission, on 3rd day and on 7th day. While it was significantly high on 7th day in SIRS, MODS, surgical ýinterference and non survival versus the corresponding groups. In MODS group The curve was rising ýallover the study period while in non MODS the curve increased up to 3rd day then decreased afterward. ýThe median values of plasma PCT levels were significantly high in septic group in comparison to non ýseptic group on 3rd day and on 7th day. In septic group The curve was rising through out study period. ýWhile in non septic group the curve showed slight increase up to 3rd day then marked decrease in the 7th ýday. In this study plasma PCT levels showed highest sensitivity, specificity, NPV and PPV in sepsis, ýMODS, SIRS and survival on 7th day in comparison to other parameters and there were positive significant ýcorrelations between PCT and ISS. Conclusions: Serum CPK levels showed highest AUC, sensitivity and ýspecificity in the prediction of SIRS group in the 3rd day in comparison to other parameters. Serum lactate ýlevels showed highest AUC, sensitivity and specificity in the prediction of sepsis, MODS and non survival ýgroups in the 3rd day in comparison to other parameters. Plasma PCT levels showed highest AUC, ýsensitivity and specificity in the prediction of SIRS, sepsis, MODS and non survival groups in the 7th day ýin comparison to other parameters.