中度严重创伤性脑损伤后脑损伤生物标志物与循环休克的关系：TRACK-TBI研究。

IF 2.3 2区医学 Q2 ANESTHESIOLOGY

Journal of neurosurgical anesthesiology Pub Date : 2023-07-01 Epub Date: 2021-12-30 DOI:10.1097/ANA.0000000000000828

Camilo Toro, Sonia Jain, Shelly Sun, Nancy Temkin, Jason Barber, Geoffrey Manley, Jordan M Komisarow, Tetsu Ohnuma, Brandon Foreman, Frederick Korley, Michael L James, Daniel Laskowitz, Monica S Vavilala, Adrian Hernandez, Joseph P Mathew, Amy J Markowitz, Vijay Krishnamoorthy

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引用次数: 0

摘要

简介创伤性脑损伤（TBI）后的早期循环休克是一个多因素过程；然而，脑损伤生物标志物对休克风险的影响尚未得到评估。我们研究了神经元损伤生物标志物水平与中重度 TBI 后发生循环休克之间的关系：在这项回顾性队列研究中，我们对患有中度严重创伤性脑损伤（格拉斯哥昏迷量表评分结果）的成人进行了研究：这项研究包括 392 名受试者，平均年龄为 40 岁；其中 314 人（80%）为男性，165 人（42%）发生了循环休克。UCH-L1 第 1 天的中位数（四分位数间距）水平（994.8 [518.7 至 1988.2] pg/mL vs. 548.1 [280.2 至 1151.9] pg/mL；P 结论：UCH-L1 是一种神经元损伤生物标志物：神经元损伤生物标志物可加深对机理的理解，并有可能及早识别中重度创伤后有早期循环休克风险的患者。

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Association of Brain Injury Biomarkers and Circulatory Shock Following Moderate-Severe Traumatic Brain Injury: A TRACK-TBI Study.

Introduction: Early circulatory shock following traumatic brain injury (TBI) is a multifactorial process; however, the impact of brain injury biomarkers on the risk of shock has not been evaluated. We examined the association between neuronal injury biomarker levels and the development of circulatory shock following moderate-severe TBI.

Methods: In this retrospective cohort study, we examined adults with moderate-severe TBI (Glasgow Coma Scale score <13) enrolled in the TRACK-TBI study, an 18-center prospective TBI cohort study. The exposures were day-1 levels of neuronal injury biomarkers (glial fibrillary acidic protein, ubiquitin C-terminal hydrolase-L1 [UCH-L1], S100 calcium-binding protein B [S100B], neuron-specific enolase), and of an inflammatory biomarker (high-sensitivity C-reactive protein). The primary outcome was the development of circulatory shock, defined as cardiovascular Sequential Organ Failure Assessment Score ≥2 within 72 hours of admission. Association between day-1 biomarker levels and the development of circulatory shock was assessed with regression analysis.

Results: The study included 392 subjects, with a mean age of 40 years; 314 (80%) were male and 165 (42%) developed circulatory shock. Median (interquartile range) day-1 levels of UCH-L1 (994.8 [518.7 to 1988.2] pg/mL vs. 548.1 [280.2 to 1151.9] pg/mL; P <0.0001) and S100B (0.47 μg/mL [0.25 to 0.88] vs. 0.27 [0.16 to 0.46] μg/mL; P <0.0001) were elevated in those who developed early circulatory shock compared with those who did not. In multivariable regression, there were associations between levels of both UCH-L1 (odds ratio, 1.63 [95% confidence interval, 1.25-2.12]; P <0.0005) and S100B (odds ratio, 1.73 [95% confidence interval 1.27-2.36]; P <0.0005) with the development of circulatory shock.

Conclusion: Neuronal injury biomarkers may provide the improved mechanistic understanding and possibly early identification of patients at risk for early circulatory shock following moderate-severe TBI.

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来源期刊

Journal of neurosurgical anesthesiology 医学-临床神经学

CiteScore

6.20

自引率

10.80%

发文量

119

审稿时长

>12 weeks

期刊介绍： The Journal of Neurosurgical Anesthesiology (JNA) is a peer-reviewed publication directed to an audience of neuroanesthesiologists, neurosurgeons, neurosurgical monitoring specialists, neurosurgical support staff, and Neurosurgical Intensive Care Unit personnel. The journal publishes original peer-reviewed studies in the form of Clinical Investigations, Laboratory Investigations, Clinical Reports, Review Articles, Journal Club synopses of current literature from related journals, presentation of Points of View on controversial issues, Book Reviews, Correspondence, and Abstracts from affiliated neuroanesthesiology societies. JNA is the Official Journal of the Society for Neuroscience in Anesthesiology and Critical Care, the Neuroanaesthesia and Critical Care Society of Great Britain and Ireland, the Association de Neuro-Anesthésiologie Réanimation de langue Française, the Wissenschaftlicher Arbeitskreis Neuroanästhesie der Deutschen Gesellschaft fur Anästhesiologie und Intensivmedizen, the Arbeitsgemeinschaft Deutschsprachiger Neuroanästhesisten und Neuro-Intensivmediziner, the Korean Society of Neuroanesthesia, the Japanese Society of Neuroanesthesia and Critical Care, the Neuroanesthesiology Chapter of the Colegio Mexicano de Anesthesiología, the Indian Society of Neuroanesthesiology and Critical Care, and the Thai Society for Neuroanesthesia.