Despite modern surgical and medical care, mortality and healthcare costs of surgical patients admitted to intensive care units (ICU) remain unacceptably high.1 As physicians, moreover, we are often limited in providing prognosis for patients and their families following critical illness. Several scoring systems of illness severity provide some population-based risk assessments but offer limited prognostic value for the individual patient.2 Plasma gelsolin is an actin-binding plasma protein that is part of an “actin-scavenging” system that buffers potentially harmful actin molecules released from injured tissues.3 Low circulating levels of plasma gelsolin may indicate significant depletion of this actin-scavenger system and may serve as a marker of injury severity in critically ill patients, consistent with the report of Mounzer et al that patients admitted to the hospital with severe trauma had lower admission plasma gelsolin levels than patients with lesser injuries.4 Since low circulating levels of plasma gelsolin have been documented in humans subjected to severe trauma, sepsis, myonecrosis, conditioning regimens for stem cell transplantation, acute respiratory distress syndrome (ARDS), and liver necrosis,4–9 and partial restoration of depressed plasma gelsolin levels ameliorated pulmonary injury in rodents exposed to hyperoxia or full-thickness burns6,10 and decreased the lethality of endotoxin or cecal ligation puncture in mice (abstract, in press), the administration of plasma gelsolin to patients with low plasma gelsolin levels and at risk for critical care complications appears worthy of consideration. We therefore measured daily plasma gelsolin levels of critically ill patients admitted to a surgical ICU (SICU) following burns, trauma, or major surgery to determine the stability or lability of plasma gelsolin levels and the predictive value of these measurements on the clinical outcome of a broader group of critically ill surgical patients.
