Serum Transthyretin is a Predictor of Clinical Outcomes in Critically Ill Trauma Patients

Background: In surgery patients, low preoperative serum transthyretin (TTR) level is associated with greater rates of infection and mortality. However, the predictive value of TTR on surgical outcomes after major trauma has not yet been studied.

Methods: Critically ill trauma patients who underwent surgery for trauma and had TTR preoperatively measured after admission to the surgical intensive care unit (ICU) at the LAC+USC Medical Center (01/2008-05/2014) were identified retrospectively. Univariable and multivariable regression analyses determined the significance of TTR on outcomes.

Results: We identified 348 patients. Univariable analysis indicated that patients with lower TTR had more infections (P < .001), higher mortality (P = .007), longer hospital stay (P < .001), longer ICU stay (P < .001), and increased ventilator days (P < .001). Even after adjusting for differences in patient characteristics, lower TTR level was associated with greater infectious complication rates (P = .001), greater mortality (P = .005), longer hospital stay (P = .013), longer ICU stay (P = .030), and increased ventilator days (P = .044).

Conclusion: In critically ill trauma patients, low serum TTR level is associated with poorer clinical outcomes, and its prognostic utility warrants further study.