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1.
Medicine (Baltimore) ; 98(44): e17806, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689863

RESUMO

Hypoalbuminemia and anemia are frequent among in patients with traumatic brain injury (TBI). We assess whether serum albumin and hemoglobin at admission can predict outcome in children with moderate to severe TBI.This retrospective study was conducted in a tertiary pediatric hospital between May 2012 and Jun 2018 included children with an admission Glasgow Coma Scale of ≤13.A total of 213 patients were included of whom 45 died in hospital. Multivariate logistic regression showed that hypoalbuminemia (serum albumin <30 g/L) was independently associated with mortality (adjusted odds ratio [OR] = 3.059; 95% confidence interval [CI]: 1.118-8.371; P = .030) in children with moderate to severe TBI, while anemia (hemoglobin <90 g/L) was not independently associated with mortality (adjusted OR = 1.742; 95% CI: 0.617-4.916; P = .295). Serum albumin was significantly superior to hemoglobin (area under the curve [AUC] 0.738 vs AUC 0.689, P < .05) under receiver operating characteristic curve analysis. Hypoalbuminemia was also associated with reduced 14-day ventilation-free days, 14-day intensive care unit (ICU)-free days, and 28-day hospital-free days.Serum albumin at admission was superior to hemoglobin in predicting the mortality in children with moderate to severe TBI and also associated with reduced ventilator-free, ICU-free, and hospital-free days.


Assuntos
Lesões Encefálicas Traumáticas/sangue , Lesões Encefálicas Traumáticas/mortalidade , Hemoglobina A Glicada/metabolismo , Mortalidade Hospitalar , Albumina Sérica/metabolismo , Anemia/complicações , Anemia/diagnóstico , Biomarcadores/sangue , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/terapia , Estudos de Casos e Controles , Criança , Pré-Escolar , Cuidados Críticos , Feminino , Escala de Coma de Glasgow , Humanos , Hipoalbuminemia/complicações , Hipoalbuminemia/diagnóstico , Masculino , Valor Preditivo dos Testes , Respiração Artificial , Estudos Retrospectivos
2.
Am Surg ; 85(8): 861-864, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31560304

RESUMO

Traumatic brain injuries in patients on antithrombotic agents carry significant morbidity. Initial therapy is centered around reversal of these agents. The thromboelastogram (TEG) maps the clotting cascade to guide reversal. A retrospective chart review was conducted for 118 patients presenting with a traumatic brain injury while on antithrombotics. Patients were divided between those who received a TEG on arrival and those who did not. The primary endpoint was overall mortality. Secondary endpoints included blood product utilization, and outcomes associated with specific novel anticoagulants. Mortality in the control group was 20.3 per cent compared with 18.5 per cent in the TEG group (P = 0.81). For less severe injuries, the control group mortality was 3.8 per cent and the TEG group mortality was 8.7 per cent (P = 0.64). For more severe injuries, mortality in the control versus TEG groups were 31.6 per cent and 25.8 per cent, respectively (P = 0.73). Blood product utilization was significantly lower in the TEG group (P = 0.002). Overall mortality was not significantly different between the groups. However, when stratified by severity of injury, mortality was reduced in the TEG-guided group in severely injured patients. Blood product utilization was significantly reduced with TEG-guided reversal. Trauma centers can improve the utilization of blood products in reversal of antithrombotics with the use of TEG.


Assuntos
Anticoagulantes/administração & dosagem , Lesões Encefálicas Traumáticas/sangue , Hemorragias Intracranianas/sangue , Ressuscitação/métodos , Tromboelastografia , Adulto , Idoso , Idoso de 80 Anos ou mais , Transfusão de Componentes Sanguíneos/estatística & dados numéricos , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/mortalidade , Feminino , Humanos , Escala de Gravidade do Ferimento , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/mortalidade , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
World Neurosurg ; 132: e613-e617, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31442647

RESUMO

BACKGROUND: Substance P is a neuropeptide belonging to the tachykinin family and is involved in neuroinflammation. In a previous study by our team, we found higher serum substance P levels on day 1 of traumatic brain injury (TBI) in nonsurviving than in surviving patients. Thus, the objective of this study was to determine whether serum substance P levels during the first week of TBI could predict early mortality. METHODS: This was a multicenter, observational, and prospective study. We included patients with an isolated severe TBI, defining isolated as <9 points in non-cranial aspects of Injury Severity Score and severe as <9 points of Glasgow Coma Scale. We determined serum substance P concentrations at days 1, 4, and 8 of TBI. We performed receiver operating characteristic analyses to determine the capacity of serum substance P levels at day 1, 4, and 8 of TBI to predict 30-day mortality. RESULTS: Nonsurviving (n = 34) compared with surviving patients (n = 90) had greater serum substance P levels on day 1 (P < 0.001), 4 (P < 0.001), and 8 (P < 0.001) of TBI. The areas under curve of serum substance P concentrations at days 1, 4, and 8 of TBI to predict 30-day mortality were 76% (P < 0.001), 87% (P < 0.001), and 89% (P < 0.001), respectively. CONCLUSIONS: The new finding of our study is that the presence of elevated serum substance P levels during the first week of TBI is associated with increased mortality.


Assuntos
Lesões Encefálicas Traumáticas/sangue , Lesões Encefálicas Traumáticas/mortalidade , Substância P/sangue , Adulto , Idoso , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
4.
J Surg Res ; 244: 1-8, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31279258

RESUMO

BACKGROUND: The pathophysiology behind the subacute but persistent hypercoagulable state after traumatic brain injury (TBI) is poorly understood but contributes to morbidity induced by venous thromboembolism. Because platelets and their microvesicles have been hypothesized to play a role in post-traumatic hypercoagulability, administration of commonly used agents may ameliorate this coagulability. We hypothesized that utilization of aspirin, ketorolac, amitriptyline, unfractionated heparin, or enoxaparin would modulate the platelet aggregation response after TBI. METHODS: Concussive TBI was induced by weight drop. Mice were then randomized to receive aspirin, ketorolac, amitriptyline, heparin, enoxaparin, or saline control at 2 and 8 h after TBI. Mice were sacrificed at 6 or 24 h after injury to determine coagulability by rotational thromboelastometry (ROTEM), platelet function testing with impedance aggregometry, and microvesicle enumeration. Platelet sphingolipid metabolites were analyzed by mass spectrometry. RESULTS: ROTEM demonstrated increased platelet contribution to maximum clot firmness at 6 h after TBI in mice that received aspirin or amitriptyline, but this did not persist at 24 h. By contrast, adenosine diphosphate- and arachidonic acid-induced platelet aggregation at 6 h was significantly lower in mice receiving ketorolac, aspirin, and amitriptyline compared with mice receiving saline at 6 h after injury and only arachidonic acid-initiated platelet aggregation was decreased by aspirin at 24 h. There were no differences in microvesicle production at either time point. Platelet sphingosine-1-phosphate levels were decreased at 6 h in the group receiving amitriptyline and increased at 24 h along with platelet ceramide levels at 24 h in the amitriptyline group. CONCLUSION: After TBI, amitriptyline decreased platelet aggregability and increased contribution to clot in a manner similar to aspirin. The amitriptyline effects on platelet function and sphingolipid metabolites may represent a possible role of the acid sphingomyelinase in the hypercoagulability observed after injury. In addition, inhibition of platelet reactivity may be an underappreciated benefit of low molecular weight heparins, such as enoxaparin.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Inibidores da Agregação de Plaquetas/administração & dosagem , Tromboembolia Venosa/prevenção & controle , Amitriptilina/administração & dosagem , Animais , Aspirina/administração & dosagem , Coagulação Sanguínea/efeitos dos fármacos , Lesões Encefálicas Traumáticas/sangue , Lesões Encefálicas Traumáticas/fisiopatologia , Modelos Animais de Doenças , Enoxaparina/administração & dosagem , Humanos , Metabolismo dos Lipídeos/efeitos dos fármacos , Masculino , Camundongos , Agregação Plaquetária/efeitos dos fármacos , Agregação Plaquetária/fisiologia , Testes de Função Plaquetária , Esfingolipídeos/metabolismo , Tromboelastografia , Tromboembolia Venosa/sangue , Tromboembolia Venosa/etiologia
5.
Bull Exp Biol Med ; 167(2): 207-209, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31236887

RESUMO

We evaluated the serum level of neuregulin-1 in humans with traumatic brain injury. The highest levels of neuregulin-1 were revealed in patients with developing post-traumatic epilepsy and the lowest concentrations of this peptide were found in healthy controls. The patients with traumatic brain injury not aggravated by the development of post-traumatic epilepsy had intermediate levels of neuregulin-1.


Assuntos
Lesões Encefálicas Traumáticas/sangue , Epilepsia Pós-Traumática/sangue , Neuregulina-1/sangue , Adulto , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
6.
Clin Chim Acta ; 496: 1-6, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31202718

RESUMO

BACKGROUND: Platelet activation is implicated in secondary brain injury following traumatic brain injury (TBI). C-type lectin-like receptor 2 (CLEC-2) is extensively expressed on platelets and participates in platelet activation. We investigate dthe prognostic significance of plasma CLEC-2 in TBI patients. METHODS: One hundred and six patients with isolated severe blunt TBI and 106 healthy controls were prospectively investigated. Plasma CLEC-2 concentrations were detected and Glasgow coma scale (GCS) scores were recorded. The relationship between plasma CLEC-2 concentrations and 30-day mortality in addition to overall survival was determined using multivariate models. RESULTS: Patients exhibited a substantially higher concentration of plasma CLEC-2 than healthy controls. Among patients, plasma CLEC-2 concentrations were remarkably increased in the GCS scores- and Rotterdam computerized tomography classification- dependent manner. As compared with survivors within posttraumatic 30 days, plasma CLEC-2 concentrations were remarkably raised in non-survivors. Rising plasma CLEC-2 concentration was independently associated with an enhanced risk of 30-day mortality and short overall survival time. Plasma CLEC-2 concentrations had a significantly high area under receiver operating characteristic curve for predicting 30-day mortality. CONCLUSIONS: Incremental plasma CLEC-2 concentrations are intimately related to increasing trauma severity, in close association with increased 30-day death, indicating the prognostic role of plasma CLEC-2 in TBI.


Assuntos
Lesões Encefálicas Traumáticas/sangue , Lesões Encefálicas Traumáticas/diagnóstico , Lectinas Tipo C/sangue , Glicoproteínas de Membrana/sangue , Adulto , Lesões Encefálicas Traumáticas/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Risco
7.
World Neurosurg ; 130: 454-458, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31252079

RESUMO

INTRODUCTION: Alcohol intoxication is often present concurrently with traumatic brain injury (TBI). Recent studies have looked at the effect alcohol has on TBI and on coagulopathy. Typically, cases reviewed in the current literature report only on the effects of modest alcohol intoxication. CASE DESCRIPTION: A 43-year-old male presented to the trauma center after a fall, with rapidly deteriorating mental status. Computed tomography of the head demonstrated a 1.9-cm acute subdural hematoma. Of note, classical coagulation studies were normal, but blood ethanol level was high, 436 mg/dL. Postoperatively, the patient suffered an intracerebral hemorrhage requiring emergent return to the operating room, where a large volume of unclotted blood and clinical coagulopathy was encountered. DISCUSSION: We review the literature pertaining to coagulopathy in the context of TBI and ethanol intoxication. This case is a cautionary tale of a phenomenon of unmeasured coagulopathy in the face of severe alcohol intoxication manifested by intraoperative coagulopathy with new postoperative hemorrhage. Although routine preoperative testing indicated normal clotting function, a thromboelastogram demonstrated delayed clot formation. The protective effects of alcohol are well described; however, we believe that there is a population of patients with severe acute intoxication who have coagulopathy that may go undetected by routine preoperative screening. CONCLUSIONS: Caution should be exercised when taking care of patients with very high levels of alcohol because physiologic derangements may be unpredictable. Additional research is needed for patients with very high levels of alcohol intoxication and the effect it may have on coagulation.


Assuntos
Acidentes por Quedas , Intoxicação Alcoólica/complicações , Lesões Encefálicas Traumáticas/etiologia , Hemorragia Cerebral Traumática/etiologia , Hematoma Subdural Agudo/etiologia , Adulto , Concentração Alcoólica no Sangue , Transtornos da Coagulação Sanguínea , Lesões Encefálicas Traumáticas/sangue , Hemorragia Cerebral Traumática/sangue , Etanol/sangue , Evolução Fatal , Hematoma Subdural Agudo/sangue , Humanos , Masculino
8.
BMC Neurosci ; 20(1): 29, 2019 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-31208341

RESUMO

BACKGROUND: Epilepsy is a common neurological disease in dogs affecting approximately 0.6-0.75% of the canine population. There is much evidence of neuroinflammation presence in epilepsy, creating new possibilities for the treatment of the disease. An increased expression of interleukin-1 beta (IL-1ß) was reported in epileptogenic foci. We hypothesized that there is an elevation of IL-1ß in serum and CSF of dogs with epilepsy, as well as in serum of dogs with TBI, reflecting involvement of this cytokine in pathophysiology of naturally occurring canine epilepsy in a clinical setting. RESULTS: IL-1ß levels were evaluated in CSF and serum of six healthy and 51 dogs with epilepsy (structural and idiopathic). In 16 dogs with TBI, only serum was tested. IL-1ß concentrations in CSF were not detectable. Serum values were not elevated in dogs with TBI in comparison to healthy controls (p > 0.05). However, dogs with epilepsy had increased levels of IL-1ß in serum (p = 0.003) regardless of the underlying cause of the disease (p = 0.0045). There was no significant relationship between the variables and IL-1ß levels. Statistically noticeable (p = 0.0630) was that approximately 10% of dog with epilepsy (R2 = 0.105) had increased seizure frequency and IL-1ß elevation. CONCLUSION: Increased IL-1ß levels were detected in the peripheral blood in dogs with idiopathic and structural epilepsy leading to the assumption that there is an involvement of inflammation in pathophysiology of epilepsy which should be considered in the search for new therapeutic strategies for this disease. However, to better understand the pathogenic role of this cytokine in epilepsy, further evaluation of IL-1ß in brain tissue is desired.


Assuntos
Lesões Encefálicas Traumáticas/veterinária , Doenças do Cão/sangue , Doenças do Cão/líquido cefalorraquidiano , Epilepsia/veterinária , Interleucina-1beta/sangue , Interleucina-1beta/líquido cefalorraquidiano , Convulsões/veterinária , Animais , Lesões Encefálicas Traumáticas/sangue , Cães , Epilepsia/sangue , Epilepsia/líquido cefalorraquidiano , Epilepsia/complicações , Feminino , Masculino , Convulsões/sangue , Convulsões/líquido cefalorraquidiano , Convulsões/complicações
9.
World Neurosurg ; 128: e434-e444, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31051301

RESUMO

OBJECTIVE: Traumatic brain injuries (TBIs) are largely underdiagnosed and may have persistent refractory consequences. Current assessments for acute TBI are limited to physical examination and imaging. Biomarkers such as glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase L1 (UCH-L1), and S100 calcium-binding protein B (S100B) have shown predictive value as indicators of TBI and potential screening tools. METHODS: In total, 37 controls and 118 unique trauma subjects who received a clinically ordered head computed tomography (CT) in the emergency department of a level 1 trauma center were evaluated. Blood samples collected at 0-8 hours (initial) and 12-32 hours (delayed) postinjury were analyzed for GFAP, UCH-L1, and S100B concentrations. These were then compared in CT-negative and CT-positive subjects. RESULTS: Median GFAP, UCH-L1, and S100B concentrations were greater in CT-positive subjects at both timepoints compared with CT-negative subjects. In addition, median UCH-L1 and S100B concentrations were lower at the delayed timepoint, whereas median GFAP concentrations were increased. As predictors of a positive CT of the head, GFAP outperformed UCH-L1 and S100B at both timepoints (initial: 0.89 sensitivity, 0.62 specificity; delayed: 0.94 sensitivity, 0.67 specificity). GFAP alone also outperformed all possible combinations of biomarkers. CONCLUSIONS: GFAP, UCH-L1, and S100B demonstrated utility for rapid prediction of a CT-positive TBI within 0-8 hours of injury. GFAP exhibited the greatest predictive power at 12-32 hours. Furthermore, these results suggest that GFAP alone has greater utility for predicting a positive CT of the head than UCH-L1, S100B, or any combination of the 3.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico , Proteína Glial Fibrilar Ácida/sangue , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Ubiquitina Tiolesterase/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas Traumáticas/sangue , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Adulto Jovem
10.
Biomed Res Int ; 2019: 5967816, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31119176

RESUMO

Traumatic brain injury (TBI) causes a wide variety of neuroinflammatory events. These neuroinflammatory events depend, to a greater extent, on the severity of the damage. Our previous studies have shown that the liver produces serum amyloid A (SAA) at high levels in the initial hours after controlled cortical impact (CCI) injury in mice. Clinical studies have reported detectable SAA in the plasma of brain injury patients, but it is not clear if SAA levels depend on TBI severity. To evaluate this question, we performed a mild to severe CCI injury in wild-type mice. We collected blood samples and brains at 1, 3, and 7 days after injury for protein detection by western blotting, enzyme-linked immunosorbent assay, or immunohistochemical analysis. Our results showed that severe CCI injury compared to mild CCI injury or sham mice caused an increased neuronal death, larger lesion volume, increased microglia/macrophage density, and augmented neutrophil infiltration. Furthermore, we found that the serum levels of SAA protein ascended in the blood in correlation with high neuroinflammatory and neurodegenerative responses. Altogether, these results suggest that serum SAA may be a novel neuroinflammation-based, and severity-dependent, biomarker for acute TBI.


Assuntos
Biomarcadores/sangue , Lesões Encefálicas Traumáticas/sangue , Encéfalo/patologia , Proteína Amiloide A Sérica/metabolismo , Animais , Lesões Encefálicas Traumáticas/patologia , Modelos Animais de Doenças , Humanos , Camundongos , Índices de Gravidade do Trauma
11.
Dis Markers ; 2019: 1065254, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31093304

RESUMO

Traumatic brain injury has been associated with increased blood glucose levels. In the present study, we set out to investigate if blood glucose level in mild head trauma could predict the need for CT. One hundred fifty-nine patients with minor TBI (GCS 13-15) and a mean age of 44.8 ± 23.8 years were included in the study. The most common mechanism of trauma was falls. Patients with positive CT findings had significantly higher glucose levels than patients with negative CT findings. Using ROC curve analysis, serum glucose levels higher than 120 mg dl-1 were the optimal cutoff value for the detection of patients with positive CT findings with a sensitivity of 74.4% and a specificity of 90.7%. Serum glucose level evaluation at presentation in the emergency department may aid CT decision-making in mild TBI.


Assuntos
Glicemia/análise , Lesões Encefálicas Traumáticas/sangue , Adulto , Idoso , Biomarcadores/sangue , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
12.
J Neurol ; 266(8): 1988-1997, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31093755

RESUMO

OBJECTIVE: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality worldwide. Metformin is reported to have pleiotropic neuroprotective effects through anti-inflammatory, antioxidative, and anti-ischemic activity, and improvements in vascular hemodynamics and endothelial function. The aim of this study is to examine the efficacy and safety of metformin therapy in severe TBI patients. METHODS: This single-blind, parallel-group, randomized controlled trial enrolled adult TBI patients. Of 158 trauma patients assessed, 30 met the eligibility criteria and were randomly allocated in a one-to-one ratio to receive 1 g metformin every 12 h for five consecutive days (intervention group) or to usual management only (control group). For efficacy analysis, temporal profiles of serum levels of S100b, neutrophil to lymphocyte ratio (NLR), and glial fibrillary acidic protein (GFAP) were assessed. For pharmacokinetic analysis, serum concentrations of metformin were evaluated in the intervention group. RESULTS: The two study groups were similar in terms of demographics, baseline clinical characteristics, and on-admission biomarkers' serum levels. Longitudinal analysis of S100b and NLR levels showed statistically significant declines in values toward normal levels in the intervention group (p values of < 0.001 and 0.030, respectively), different from the profiles of the control group (p values of 0.074 and 0.645, respectively). Pharmacokinetic analysis demonstrated that metformin absorption is delayed in TBI patients. No events of hypoglycemia and lactic acidosis occurred. CONCLUSIONS: Metformin could potentially be an effective and safe therapeutic intervention in patients with severe TBI. Large-scale, multicentre studies are needed to confirm our encouraging results.


Assuntos
Lesões Encefálicas Traumáticas/sangue , Lesões Encefálicas Traumáticas/tratamento farmacológico , Metformina/sangue , Metformina/uso terapêutico , Índice de Gravidade de Doença , Adulto , Biomarcadores/sangue , Lesões Encefálicas Traumáticas/diagnóstico , Feminino , Seguimentos , Humanos , Hipoglicemiantes/efeitos adversos , Hipoglicemiantes/sangue , Hipoglicemiantes/uso terapêutico , Estudos Longitudinais , Masculino , Metformina/efeitos adversos , Pessoa de Meia-Idade , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Método Simples-Cego , Resultado do Tratamento , Adulto Jovem
13.
Transfusion ; 59(S2): 1522-1528, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30980753

RESUMO

Traumatic brain injury (TBI)-induced coagulopathy has long been recognized as a significant risk for poor outcomes in patients with TBI, but its pathogenesis remains poorly understood. As a result, current treatment options for the condition are limited and ineffective. The lack of information is most significant for the impact of blood transfusions on patients with isolated TBI and in the absence of confounding influences from trauma to the body and limbs and the resultant hemorrhagic shock. Here we discuss recent progress in understanding the pathogenesis of TBI-induced coagulopathy and the current state of blood transfusions for patients with TBI and associated coagulopathy.


Assuntos
Transtornos da Coagulação Sanguínea , Transfusão de Sangue , Lesões Encefálicas Traumáticas , Choque Hemorrágico , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/complicações , Transtornos da Coagulação Sanguínea/terapia , Lesões Encefálicas Traumáticas/sangue , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/terapia , Humanos , Choque Hemorrágico/sangue , Choque Hemorrágico/complicações , Choque Hemorrágico/terapia
14.
Clin Chim Acta ; 495: 227-232, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31009601

RESUMO

BACKGROUND: Severe traumatic brain injury (sTBI) is characterized by a high mortality. Tumor necrosis factor-like weak inducer of apoptosis (TWEAK) participates in inflammation. We determined serum soluble TWEAK (sTWEAK) levels with respect to its prognostic ability. METHODS: This was a single-center prospective, observational study that was performed from December 2014 to December 2017. A total of 114 sTBI patients who met the inclusion criteria and 114 randomly selected healthy controls were included in the study. Serum sTWEAK levels were gauged. Patients were followed-up until death or completion of 6 months. Poor outcome was referred to as Glasgow outcome scale score of 1-3. RESULTS: In comparison with controls, patients displayed predominantly higher serum sTWEAK levels. Serum sTWEAK levels were strongly correlated with Glasgow coma scale scores and serum C-reactive protein levels. 32 patients (28.1%) died and 60 patients (52.6%) suffered from a poor outcome. Receiver operating characteristic curve analysis clearly showed that serum sTWEAK levels had substantially high predictive performance for 6-month mortality and poor outcome. Serum sTWEAK emerged as an independent predictor for 6-month mortality, overall survival and poor outcome. CONCLUSIONS: Raised serum sTWEAK levels are closely related to increasing inflammatory response, elevated trauma severity and worse clinical outcome after sTBI.


Assuntos
Lesões Encefálicas Traumáticas/sangue , Lesões Encefálicas Traumáticas/diagnóstico , Citocina TWEAK/sangue , Citocina TWEAK/química , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Solubilidade , Adulto Jovem
15.
World Neurosurg ; 126: e959-e964, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30876987

RESUMO

BACKGROUND: Traumatic brain injury (TBI) is a major cause of death and disability. This study evaluated a possible relationship between serum factors at admission and the outcome of TBI. We propose a statistically validated scale for patients with TBI that combines serum factors and the Glasgow Coma Scale (GCS). METHODS: Between May 2011 and July 2016, 219 patients underwent decompressive craniectomy for TBI. We assessed laboratory data on admission, and correlations with GSC and Glasgow Outcome Scale were investigated. The modified GCS was developed from a multivariable logistic regression model, which was validated with the backward stepwise method. RESULTS: Of 219 patients with TBI enrolled in our study, 175 were men (79.9%) and 44 were women (20.1%) with a mean age of 49.1 ± 11.5 years. Initial serum values of hemoglobin, platelets, prothrombin time, and lactate dehydrogenase were associated with in-hospital mortality. The factor score was derived by adding the following points: hemoglobin (≥13.0 g/dL = 0, <13.0 g/dL = 1), platelets (≥150 × 103/mm3 = 0, <150 × 103/mm3 = 1), prothrombin time (<13.2 seconds = 0, ≥13.2 seconds = 1), and lactate dehydrogenase (<271 U/L = 0, ≥271 U/L = 1). The modified GCS score (GCS score [range, 6-15] - FS [range, 0-4]) was calculated. CONCLUSIONS: The modified GCS score using serum factors extended the information provided about patient outcomes to be comparable to more complex methods. The modified GCS score may be useful to predict in-hospital mortality in patients with TBI.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico , Escala de Coma de Glasgow , Hemoglobinas/análise , Contagem de Plaquetas , Tempo de Protrombina , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Lesões Encefálicas Traumáticas/sangue , Feminino , Humanos , L-Lactato Desidrogenase/sangue , Masculino , Pessoa de Meia-Idade , Prognóstico , Adulto Jovem
16.
PLoS One ; 14(3): e0214381, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30901365

RESUMO

BACKGROUND: Diffuse axonal injury (DAI) is difficult to identify in the early phase of traumatic brain injury (TBI) using common diagnostic methods. Tau protein is localized specifically in nerve axons. We hypothesized that serum level of tau can be a useful biomarker to diagnose DAI in the early phase of TBI. METHODS & RESULTS: We measured serum tau levels in 40 TBI patients who were suspected of DAI within 6 hours after TBI to evaluate the accuracy of the tau level as a diagnostic marker for DAI. Diagnosis of DAI was confirmed according to magnetic resonance imaging (MRI) findings. The serum tau level in the DAI group (n = 13) was significantly higher than that in the non-DAI group (n = 27) (DAI vs. non-DAI, 25.3 [0 to 99.1] pg/mL vs. 0 [0 to 44.4] pg/mL, P = 0.03)). A receiver-operating characteristic curve to evaluate the diagnostic ability of serum tau level within 6 hours for DAI showed an area under the curve of 0.690 with 74.1% for sensitivity and 69.2% for specificity. Serum tau level was not significantly higher in unfavorable outcome group (Glasgow Outcome scale [GOS] score = 1-3 at hospital discharge) compared with favorable outcome group (GOS score = 4-5) (P = 0.19). CONCLUSIONS: Tau protein may be a useful biomarker for diagnosis of DAI in the early phase of TBI.


Assuntos
Biomarcadores/sangue , Lesões Encefálicas Traumáticas/diagnóstico , Lesão Axonal Difusa/diagnóstico , Proteínas tau/sangue , Adulto , Idoso , Área Sob a Curva , Lesões Encefálicas Traumáticas/sangue , Lesão Axonal Difusa/sangue , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Regulação para Cima
17.
Ulus Travma Acil Cerrahi Derg ; 25(2): 193-197, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30892675

RESUMO

BACKGROUND: Since understanding the fact that traumatic brain injury includes an inflammatory process, the number of studies of cytokines has increased. The objective of this study was to analyze and discuss the association of interleukin (IL)-8 level with the clinical and radiological status of patients with head trauma. METHODS: Patients who were admitted to our hospital due to head trauma were included in the study. Findings of clinical and laboratory examinations were analyzed. Data regarding patient age, gender, available clinical findings, Glasgow Coma Scale (GCS) score, trauma cause, brain tomography findings, and biochemical laboratory test results were recorded. The patients were divided into 3 groups according to their GCS score: Group I: GCS ≥13, Group II: GCS = 9-12, and Group III: GCS = 3-8. RESULTS: A total of 23 (76.7%) patients were male and 7 (23.3%) were female. Overall, 17 (56.7%) patients were admitted due to a fall, 8 (26.7%) due to a traffic accident, and 5 (16.7%) due to assault. Each group comprised 10 patients. As the GCS score increased, the IL-8 level decreased. The mean IL-8 level was 1.2 pg/mL in Group I, 6.6 pg/mL in Group II, and 4.7 pg/mL in Group III; however, there was no statistically significant difference between the groups (p=0.147). Moreover, the IL-8 level was significantly greater in patients who demonstrated an abnormal tomography finding (p=0.023). CONCLUSION: IL-8 may be a beneficial indicator for monitoring the clinical and radiological status of traumatic brain injury. Nonetheless, studies of larger cohorts in which IL-8 levels are measured at all stages of brain injury and follow-up of long-term prognosis are warranted.


Assuntos
Lesões Encefálicas Traumáticas , Interleucina-8/sangue , Lesões Encefálicas Traumáticas/sangue , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/epidemiologia , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Tomografia Computadorizada por Raios X
18.
World Neurosurg ; 126: e1537-e1541, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30926559

RESUMO

BACKGROUND: Soluble cluster of differentiation 40 ligand (sCD40L) is a member of the tumor necrosis factor family with proinflamatory and procoagulant effects. A previous study found higher serum sCD40L levels at day 1 of traumatic brain injury (TBI) in nonsurviving than surviving patients. Thus the objective of this study was to compare serum sCD40L levels during the first week of a severe TBI between surviving and nonsurviving patients and to determine whether it could be used as a mortality predictor biomarker. METHODS: In this multicenter study severe TBI patients (with Glasgow Coma Scale score <9) with an Injury Severity Score in noncranial item <9 were included. Serum sCD40L concentrations at days 1, 4, and 8 of TBI were determined. We performed receiver operating characteristic analyses to determine the capacity of 30-day TBI mortality prediction by serum sCD40L levels at days 1, 4, and 8 of TBI. RESULTS: We found that nonsurviving (n = 34) patients in comparison with surviving (n = 90) patients had higher sCD40L levels on days 1 (P < 0.001), 4 (P = 0.004), and 8 (P < 0.001) of TBI. We also found that the areas under curve of serum sCD40L concentrations at days 1, 4, and 8 of TBI to 30-day mortality prediction were 82% (P < 0.001), 72% (P = 0.01) and 83% (P < 0.001), respectively. CONCLUSIONS: The existence of higher serum sCD40L levels in nonsurviving than surviving patients during the first week of TBI and fact that serum sCD40L levels during the first week of TBI can be used as a mortality predictor biomarker are the new findings of our study.


Assuntos
Lesões Encefálicas Traumáticas/sangue , Lesões Encefálicas Traumáticas/mortalidade , Ligante de CD40/sangue , Adulto , Idoso , Biomarcadores , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Análise de Sobrevida
19.
Eur J Endocrinol ; 180(5): 281-290, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30884465

RESUMO

Objectives Childhood traumatic brain injury (TBI) is a public health issue. Our objectives were to determine the prevalence of permanent pituitary hormone deficiency and to detect the emergence of other pituitary dysfunctions or central precocious puberty several years after severe TBI. Design Follow-up at least 5 years post severe TBI of a prospective longitudinal study. Patients Overall, 66/87 children, who had endocrine evaluation 1 year post severe TBI, were included (24 with pituitary dysfunction 1 year post TBI). Main outcome measures In all children, the pituitary hormones basal levels were assessed at least 5 years post TBI. Growth hormone (GH) stimulation tests were performed 3-4 years post TBI in children with GH deficiency (GHD) 1 year post TBI and in all children with low height velocity (<-1 DS) or low IGF-1 (<-2 DS). Central precocious puberty (CPP) was confirmed by GnRH stimulation test. Results Overall, 61/66 children were followed up 7 (5-10) years post TBI (median; (range)); 17/61 children had GHD 1 year post TBI, and GHD was confirmed in 5/17 patients. For one boy, with normal pituitary function 1 year post TBI, GHD was diagnosed 6.5 years post TBI. 4/61 patients developed CPP, 5.7 (2.4-6.1) years post-TBI. Having a pituitary dysfunction 1 year post TBI was significantly associated with pituitary dysfunction or CPP more than 5 years post TBI. Conclusion Severe TBI in childhood can lead to permanent pituitary dysfunction; GHD and CPP may appear after many years. We recommend systematic hormonal assessment in children 1 year after severe TBI and a prolonged monitoring of growth and pubertal maturation. Recommendations should be elaborated for the families and treating physicians.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Hipopituitarismo/etiologia , Puberdade Precoce/etiologia , Adolescente , Hormônio Adrenocorticotrópico/sangue , Lesões Encefálicas Traumáticas/sangue , Criança , Pré-Escolar , Feminino , Seguimentos , Hormônio do Crescimento Humano/sangue , Humanos , Hipopituitarismo/sangue , Lactente , Masculino , Estudos Prospectivos , Puberdade Precoce/sangue , Tireotropina/sangue
20.
World Neurosurg ; 126: e1421-e1426, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30904798

RESUMO

OBJECTIVE: To investigate the acute and long-term effects of vitamin D supplementation on the recovery of patients with traumatic brain injury (TBI). METHODS: A retrospective study was conducted involving 345 patients with TBI who visited a single trauma center. Vitamin D serum levels were measured without supplementation at admission, 1 month, and 3 months post-TBI (control group) from August to December 2016. From January 2017, vitamin D supplementation was provided to patients with TBI with low vitamin D serum levels at admission (supplement group). The outcomes were investigated by assessing performance function (Extended Glasgow Outcome Scale) and cognitive function (Mini-Mental Status Examination, and Clinical Dementia Rating) at 1 week and 3 months post-TBI. RESULTS: The mean vitamin D serum level in patients with TBI at admission was 13.62 ± 9.01 ng/mL. The level significantly increased from 14.03 ± 8.68 ng/mL at admission to 37.42 ± 12.57 ng/mL at 3 months post TBI in the supplement group (P < 0.001). The cognitive outcomes (Mini-Mental Status Examination/Clinical Dementia Rating, P = 0.042/P = 0.044) and GOS-E score (total TBI, P = 0.003; mild-to-moderate TBI, P = 0.002) significantly improved from the first week to 3 months post TBI in the patients with vitamin D supplementation. CONCLUSIONS: Administration of vitamin D supplements in mild-to-moderate TBI patients with significant vitamin D deficiency during the acute phase of the injury may improve long-term performance and cognitive outcomes. Therefore, the treatment strategies should be individually planned for the patients with TBI based on their baseline vitamin D level.


Assuntos
Lesões Encefálicas Traumáticas/sangue , Lesões Encefálicas Traumáticas/complicações , Suplementos Nutricionais , Deficiência de Vitamina D/complicações , Vitamina D/sangue , Adulto , Lesões Encefálicas/sangue , Lesões Encefálicas/complicações , Cognição/efeitos dos fármacos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica/efeitos dos fármacos , Estudos Retrospectivos , Vitamina D/farmacologia
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