Correlation analysis of salivary cytokines and hormones with resiliency.

BACKGROUND: Frequent exposure to acute stress increases risk of suicide, posttraumatic stress disorder, and other stress-related disorders. Neuroendocrine and immunologic dysregulation associated with stress may underlie predispositions to psychological disorders and inflammatory disease processes in individuals, such as first-responders and other healthcare professionals, who function in high stress situations. The Hardiness Resilience Gauge (HRG) can be used to psychometrically measure resilience, a psychological modifier of the stress response. Using the HRG alongside salivary biomarker profiling, may help to identify low resilience phenotypes and allow mitigation and early therapeutic interventions. There is a paucity of knowledge regarding biomarkers of resilience. This study aims to evaluate the relationship between factors of resilience with salivary biomarker levels and fluctuations during and following acute stress. METHODS: Sixty-three first responders underwent a standardized stress-inducing training exercise, providing salivary samples before (prestress), immediately after (post-stress), and 1 hour after the event (recovery). The HRG was administered before (initial) and after (final) the event. Multiplex ELISA panels quantified 42 cytokines and 6 hormones from the samples, which were analyzed for relationships to psychometric factors of resilience measured by the HRG. RESULTS: Several biomarkers correlated with psychological resilience following the acute stress event. The HRG scores correlated ( p < 0.05) with a select set of biomarkers with moderate-to-strong correlations (|r| > 0.3). These included EGF, GROα, PDGFAA, TGFα, VEGFA, interleukin (IL)1Ra, TNFα, IL18, cortisol, FGF2, IL13, IL15, and IL6. Interestingly, fluctuations of EGF, GROα, and PDGFAA in post-stress compared with recovery were positively correlated with factors of resilience, which were negatively correlated from the pre-stress to post-stress period. CONCLUSION: This exploratory analysis discovered a small subset of salivary biomarkers that are significantly correlated with acute stress and resilience. Further investigation of their specific roles in acute stress and associations with resiliency phenotypes is warranted.

Utility of the risk assessment profile for risk stratification of venous thrombotic events for trauma patients.

BACKGROUND: Trauma patients are at risk for the development of venous thromboembolism (VTE). The purpose of this study was to validate the Risk Assessment Profile (RAP) as a tool for stratifying the risk of VTE. METHODS: RAP scores were calculated in a retrospective cohort analysis for all trauma patients aged 13 years or older admitted in 2003 and 2006 and hospitalized longer than 48 hours. Association of RAP with VTE, sensitivity, specificity, and receiver operating characteristic curve were included in the analysis. RESULTS: Of 2,281 patients, deep vein thrombosis (DVT) developed in 239 (10.5%) and pulmonary embolism (PE) developed in 34 (1.5%). In moderate- and high-risk patients, the RAP had a sensitivity of .82 and a specificity of .57. Identification of VTE for high-risk patients had a sensitivity .15 and a specificity of .97. The incidence of VTE increased significantly with risk level regardless of mechanism of injury. CONCLUSIONS: The RAP score is highly associated with VTE in trauma patients regardless of mechanism of injury and is a valid risk assessment tool.

Use of volunteer student abstractors for a retrospective cohort analysis: a study of inter-rater reliability.

BACKGROUND: Little is known about the reliability of data collected by abstractors without professional medical training. This investigation sought to determine the level of agreement among untrained volunteer abstractors as part of a study to evaluate the risk assessment of venous thromboembolism in patients who have undergone trauma. METHODS: Forty-nine paper charts were chosen randomly from a volunteer-reviewed cohort of 2,339 and were compared with those of a single experienced abstractor. Inter-rater agreement was assessed using percent agreement, Cohen's kappa, and prevalence-adjusted bias-adjusted kappa (PABAK). RESULTS: Of the 71 data points, 28 had perfect agreement. The average agreement across all charts was 97%. Data with imperfect agreement had kappa values between .27 and .96 (mean, .75), with one additional value at zero even though it was associated with an agreement of 94%. PABAK values ranged from .67 to .98 (mean, .91), an average increase of .17 compared with kappa values. CONCLUSIONS: The performance of volunteers showed outstanding inter-rater reliability; however, limitations of interpretation can influence reliability.