Extracellular micronutrient levels and pro-/antioxidant status in trauma patients with wound healing disorders: results of a cross-sectional study

Background: Disorders in wound healing (DWH) are common in trauma patients, the reasons being not completely understood. Inadequate nutritional status may favor DWH, partly by means of oxidative stress. Reliable data, however, are lacking. This study should investigate the status of extracellular micronutrients in patients with DWH within routine setting. Methods: Within a cross-sectional study, the plasma/serum status of several micronutrients (retinol, ascorbic acid, 25-hydroxycholecalciferol,alpha-tocopherol, beta-carotene, selenium, and zinc) were determined in 44 trauma patients with DWH in addition to selected proteins (albumin, prealbumin, and C-reactive protein; CRP) and markers of pro-/antioxidant balance (antioxidant capacity, peroxides, and malondialdehyde). Values were compared to reference values to calculate the prevalence for biochemical deficiency. Correlations between CRP, albumin and prealbumin, and selected micronutrients were analyzed by Pearson's test. Statistical significance was set at P < 0.05. Results: Mean concentrations of ascorbic acid (23.1 +/- 15.9 mu mol/L), 25-hydroxycholecalciferol (46.2 +/- 30.6 nmol/L), beta-carotene (0.6 +/- 0.4 mu mol/L), selenium (0.79 +/- 0.19 mu mol/L), and prealbumin (24.8 +/- 8.2 mg/dL) were relatively low. Most patients showed levels of ascorbic acid (< 28 mu mol/L; 64%), 25-hydroxycholecalciferol (< 50 mu mol/L; 59%), selenium (<= 94 mu mol/L; 71%) and beta-carotene (< 0.9 mu mol/L; 86%) below the reference range. Albumin and prealbumin were in the lower normal range and CRP was mostly above the reference range. Plasma antioxidant capacity was decreased, whereas peroxides and malondialdehyde were increased compared to normal values. Inverse correlations were found between CRP and albumin (P < 0.05) and between CRP and prealbumin (P < 0.01). Retinol (P < 0.001), ascorbic acid (P < 0.01), zinc (P < 0.001), and selenium (P < 0.001) were negatively correlated with CRP. Conclusions: Trauma patients with DWH frequently suffer from protein malnutrition and reduced plasma concentrations of several micronutrients probably due to inflammation, increased requirement, and oxidative burden. Thus, adequate nutritional measures are strongly recommended to trauma patients.