Early systemic insults following traumatic brain injury: association with biomarker profiles, therapy for intracranial hypertension, and neurological outcomes-an analysis of CENTER-TBI data.
Early systemic insults following traumatic brain injury- association with biomarker profiles, therapy for intracranial hypertension, and neurological outcomes-an analysis of CENTER-TBI data..pdf
[en] PURPOSE: We analysed the impact of early systemic insults (hypoxemia and hypotension, SIs) on brain injury biomarker profiles, acute care requirements during intensive care unit (ICU) stay, and 6-month outcomes in patients with traumatic brain injury (TBI). METHODS: From patients recruited to the Collaborative European neurotrauma effectiveness research in TBI (CENTER-TBI) study, we documented the prevalence and risk factors for SIs and analysed their effect on the levels of brain injury biomarkers [S100 calcium-binding protein B (S100B), neuron-specific enolase (NSE), neurofilament light (NfL), glial fibrillary acidic protein (GFAP), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and protein Tau], critical care needs, and 6-month outcomes [Glasgow Outcome Scale Extended (GOSE)]. RESULTS: Among 1695 TBI patients, 24.5% had SIs: 16.1% had hypoxemia, 15.2% had hypotension, and 6.8% had both. Biomarkers differed by SI category, with higher S100B, Tau, UCH-L1, NSE and NfL values in patients with hypotension or both SIs. The ratio of neural to glial injury (quantified as UCH-L1/GFAP and Tau/GFAP ratios) was higher in patients with hypotension than in those with no SIs or hypoxia alone. At 6 months, 380 patients died (22%), and 759 (45%) had GOSE ≤ 4. Patients who experienced at least one SI had higher mortality than those who did not (31.8% vs. 19%, p < 0.001). CONCLUSION: Though less frequent than previously described, SIs in TBI patients are associated with higher release of neuronal than glial injury biomarkers and with increased requirements for ICU therapies aimed at reducing intracranial hypertension. Hypotension or combined SIs are significantly associated with adverse 6-month outcomes. Current criteria for hypotension may lead to higher biomarker levels and more negative outcomes than those for hypoxemia suggesting a need to revisit pressure targets in the prehospital settings.
Disciplines :
Human health sciences: Multidisciplinary, general & others
Author, co-author :
Robba, Chiara; Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy. ; IRCCS Policlinico San Martino, Genoa, Italy.
Graziano, Francesca; Biostatistics and Clinical Epidemiology, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy. ; Bicocca Bioinformatics Biostatistics and Bioimaging Center B4, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Picetti, Edoardo; Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy.
Åkerlund, Cecilia; Section of Anesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden. ; Function Perioperative Medicine and Intensive Care, Karolinska University Hospital Solna, Stockholm, Sweden.
Addis, Alberto; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. ; NeuroIntensive Care Unit, Neuroscience Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy.
Pastore, Giuseppe; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Sivero, Mattia; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Rebora, Paola; Biostatistics and Clinical Epidemiology, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy. ; Bicocca Bioinformatics Biostatistics and Bioimaging Center B4, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Galimberti, Stefania; Biostatistics and Clinical Epidemiology, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy. ; Bicocca Bioinformatics Biostatistics and Bioimaging Center B4, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Stocchetti, Nino; Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy. ; Department of Physiopathology and Transplant, Milan University, Milan, Italy.
Maas, Andrew; Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium.
Menon, David K; Neurocritical Care Unit, Addenbrooke's Hospital, Cambridge, UK.
Citerio, Giuseppe ; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. giuseppe.citerio@unimib.it. ; NeuroIntensive Care Unit, Neuroscience Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy. giuseppe.citerio@unimib.it.
Early systemic insults following traumatic brain injury: association with biomarker profiles, therapy for intracranial hypertension, and neurological outcomes-an analysis of CENTER-TBI data.
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