THE NOVEL MARKER OF REACTIVE HEPATITIS IN INJURED WITH GUNSHOT WOUNDS

Abstract

Objective. The aim of the study was to improve the diagnosis of reactive hepatitis in injured with gunshot wounds. Methods. A retrospective analysis of 373 medical histories of servicemen wounded during the war in eastern Ukraine in 2014-2020, 233 of whom were hospitalized at the National Military Medical Clinical Center (NMMCC) and military medical clinical centres of the North, South, Eastern regions of the Ministry of Defense of Ukraine for more than 14 days. All servicemen had laboratory examinations using unified methods of laboratory tests. The obtained data were processed using non-parametric statistical methods. Results. The median baseline of ALT and, to a greater extent, AST (in the first period of traumatic illness) exceeds the upper limit of normal (40 IU / l). The highest values ​​of ALT were observed in the second period of traumatic illness on the 5th and 10th day of observation with a slight decrease in the next stage of the study. The concentration of AST increased significantly in the first period of traumatic illness, almost did not decrease in the second period, but approached normal values ​​≥14 days after injury. The strongest correlation between transaminases and albumin levels was found. A new calculated indicator in the form of the ratio of ALT concentration to albumin concentration (coefficient of reactive hepatitis of the injured, CRGI) is proposed. The development of post-traumatic reactive hepatitis was confirmed in all cases with the wounded with the value of CRGI ≥2.0. Conclusions. 1. Based on a retrospective analysis of 373 case histories of wounded in different periods after a gunshot wound, a new calculated indicator is proposed - the coefficient of reactive hepatitis of the injured (CRGI) in the form of the ratio of ALT/albumin concentrations, the increase of which indicates hepatocellular damage of hepatocytes with simultaneous suppression of the protein-synthetic function of the liver on the background of catabolic reactions. 2. CRGI ≥2 indicates the development of reactive hepatitis, is most often observed in the second period of traumatic illness and tends to normalize in the background of effective treatment. In the wounded who died as a result of injuries, CRGI steadily increased and was significantly higher than in the wounded with the uncomplicated course, especially in the third period of traumatic illness - after 14 days or more (4.0 vs. 2.3, respectively), which indicates the possible use of the proposed indicator as a prognostic criterion for worsening the prognosis in the wounded.