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Chapter 2: Systemic Response to Injury and Metabolic Support

C-reactive protein (CRP)

A. Is secreted in a circadian rhythm with higher levels in the morning

B. Increases after eating a large meal

C. Does not increase in response to stress in patients with liver failure

D. Is less sensitive than erythrocyte sedimentation rate as a marker of inflammation

Answer: C

The acute phase proteins are nonspecific biochemical markers produced by hepatocytes in response to tissue injury, infection, or inflammation. Interleukin (IL)-6 is a potent inducer of acute phase proteins that can include proteinase inhibitors, coagulation and complement proteins, and transport proteins. Clinically, only C-reactive protein (CRP) has been consistently used as a marker of injury response due to its dynamic reflection of inflammation. Importantly, CRP levels do not show diurnal variations and are not affected by feeding. Only pre-existing liver failure will impair CRP production. Therefore, it has become a useful biomarker of inflammation as well as response to treatment. Its accuracy surpasses that of the erythrocyte sedimentation rate. (See Schwartz 10th ed., p.17.)

Which of the following is true regarding the inflammatory response following traumatic injury?

A. There is an acute proinflammatory response caused by stimulation of the adaptive immune system.

B. There is an anti-inflammatory response that leads to a return to homeostasis accompanied suppression of the innate immune system.

C. The degree of inflammation is proportional to injury severity.

D. Systemic inflammation following trauma is related to the immune response to microbes.

Answer: C

The degree of the systemic inflammatory response following trauma is proportional to injury severity and is an independent predictor of subsequent organ dysfunction and resultant mortality. Recent work has provided insight into the mechanisms by which immune activation in this setting is triggered. The clinical features of the injury-mediated systemic inflammatory response, characterized by increased body temperature, heart rate, respirations, and white blood cell count, are similar to those observed with infection. While significant efforts have been devoted to establishing a microbial etiology for this response, it is now widely accepted that systemic inflammation following trauma is sterile. (See Schwartz 10th ed., p.14.)

High-mobility group protein B1 (HMGB1)

A. Is associated with the best-characterized damage-associated molecular pattern (DAMP), detectable in the circulation within 30 minutes of trauma

B. Is a protein secreted by immune-competent cells stimulated by ...

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