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Săcărescu A, Turliuc MD. Electrolyte Imbalance in Acute Traumatic Brain Injury: Insights from the First 24 h. Clin Pract 2024; 14:1767-1778. [PMID: 39311291 PMCID: PMC11417862 DOI: 10.3390/clinpract14050141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/25/2024] [Accepted: 08/28/2024] [Indexed: 09/26/2024] Open
Abstract
BACKGROUND/OBJECTIVES Electrolyte disturbances are common in patients with traumatic brain injury (TBI), particularly affecting sodium, potassium, chloride, and calcium levels. This study aims to provide insights into these disturbances within the first 24 h post-injury. METHODS We conducted a cross-sectional analysis of 50 TBI patients, excluding those with conditions affecting electrolyte balance. Electrolyte levels were measured, and correlations with demographic data, trauma mechanisms, imaging findings, and Glasgow Coma Scale (GCS) scores were analyzed. RESULTS The results indicated that chloride levels inversely correlated with GCS scores (ρ = -0.515; p = 0.002), suggesting that elevated chloride may indicate severe neurological impairment. Potassium levels were significantly associated with subdural hematoma (p = 0.032) and subarachnoid hemorrhage (p = 0.043), highlighting their potential as markers for severe brain injuries. No significant associations were found between sodium or calcium levels and the studied variables. CONCLUSIONS These findings underscore the importance of early monitoring of chloride and potassium levels in TBI patients to improve management and outcomes. Future research should focus on larger, multi-center studies to validate these findings and develop comprehensive guidelines for managing electrolyte imbalances in TBI patients.
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Affiliation(s)
- Alina Săcărescu
- Department of Medical Specialties III, “Grigore T. Popa” University of Medicine and Pharmacy, Universității 16, 700115 Iași, Romania
- Department of Neurology, Clinical Rehabilitation Hospital, Pantelimon Halipa 14, 700661 Iași, Romania
| | - Mihaela-Dana Turliuc
- Department of Surgery II, “Grigore T. Popa” University of Medicine and Pharmacy, Universitătii 16, 700115 Iași, Romania;
- Department of Neurosurgery I, “Prof. Dr. N. Oblu” Clinical Emergency Hospital, Ateneului 2, 700309 Iași, Romania
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Kocik VI, April MD, Rizzo JA, Dengler BA, Schauer SG. A Review of Electrolyte, Mineral, and Vitamin Changes After Traumatic Brain Injury. Mil Med 2024; 189:e101-e109. [PMID: 37192042 DOI: 10.1093/milmed/usad112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/27/2023] [Accepted: 03/24/2023] [Indexed: 05/18/2023] Open
Abstract
INTRODUCTION Despite the prevalence of traumatic brain injury (TBI) in both civilian and military populations, the management guidelines developed by the Joint Trauma System involve minimal recommendations for electrolyte physiology optimization during the acute phase of TBI recovery. This narrative review aims to assess the current state of the science for electrolyte and mineral derangements found after TBI. MATERIALS AND METHODS We used Google Scholar and PubMed to identify literature on electrolyte derangements caused by TBI and supplements that may mitigate secondary injuries after TBI between 1991 and 2022. RESULTS We screened 94 sources, of which 26 met all inclusion criteria. Most were retrospective studies (n = 9), followed by clinical trials (n = 7), observational studies (n = 7), and case reports (n = 2). Of those, 29% covered the use of some type of supplement to support recovery after TBI, 28% covered electrolyte or mineral derangements after TBI, 16% covered the mechanisms of secondary injury after TBI and how they are related to mineral and electrolyte derangements, 14% covered current management of TBI, and 13% covered the potential toxic effects of the supplements during TBI recovery. CONCLUSIONS Knowledge of mechanisms and subsequent derangements of electrolyte, mineral, and vitamin physiology after TBI remains incomplete. Sodium and potassium tended to be the most well-studied derangements after TBI. Overall, data involving human subjects were limited and mostly involved observational studies. The data on vitamin and mineral effects were limited, and targeted research is needed before further recommendations can be made. Data on electrolyte derangements were stronger, but interventional studies are needed to assess causation.
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Affiliation(s)
| | - Michael D April
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- 40th Forward Resuscitative Surgical Detachment, Fort Carson, CO 80902, USA
| | - Julie A Rizzo
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Bradley A Dengler
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Steven G Schauer
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234, USA
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Freire MAM, Rocha GS, Bittencourt LO, Falcao D, Lima RR, Cavalcanti JRLP. Cellular and Molecular Pathophysiology of Traumatic Brain Injury: What Have We Learned So Far? BIOLOGY 2023; 12:1139. [PMID: 37627023 PMCID: PMC10452099 DOI: 10.3390/biology12081139] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
Traumatic brain injury (TBI) is one of the leading causes of long-lasting morbidity and mortality worldwide, being a devastating condition related to the impairment of the nervous system after an external traumatic event resulting in transitory or permanent functional disability, with a significant burden to the healthcare system. Harmful events underlying TBI can be classified into two sequential stages, primary and secondary, which are both associated with breakdown of the tissue homeostasis due to impairment of the blood-brain barrier, osmotic imbalance, inflammatory processes, oxidative stress, excitotoxicity, and apoptotic cell death, ultimately resulting in a loss of tissue functionality. The present study provides an updated review concerning the roles of brain edema, inflammation, excitotoxicity, and oxidative stress on brain changes resulting from a TBI. The proper characterization of the phenomena resulting from TBI can contribute to the improvement of care, rehabilitation and quality of life of the affected people.
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Affiliation(s)
- Marco Aurelio M. Freire
- Graduate Program in Physiological Sciences, University of the State of Rio Grande do Norte, Mossoró 59607-360, RN, Brazil
| | - Gabriel Sousa Rocha
- Graduate Program in Biochemistry and Molecular Biology, University of the State of Rio Grande do Norte, Mossoró 59607-360, RN, Brazil
| | - Leonardo Oliveira Bittencourt
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém 66075-900, PA, Brazil
| | - Daniel Falcao
- VCU Health Systems, Virginia Commonwealth University, 23219 Richmond, VA, USA
| | - Rafael Rodrigues Lima
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém 66075-900, PA, Brazil
| | - Jose Rodolfo Lopes P. Cavalcanti
- Graduate Program in Physiological Sciences, University of the State of Rio Grande do Norte, Mossoró 59607-360, RN, Brazil
- Graduate Program in Biochemistry and Molecular Biology, University of the State of Rio Grande do Norte, Mossoró 59607-360, RN, Brazil
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Ngatuvai M, Martinez B, Sauder M, Beeton G, Andrade R, Maka P, Smith CP, Kornblith L, Elkbuli A. Traumatic Brain Injury, Electrolyte Levels, and Associated Outcomes: A Systematic Review. J Surg Res 2023; 289:106-115. [PMID: 37087837 DOI: 10.1016/j.jss.2023.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/26/2023] [Accepted: 03/17/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Although it has been established that electrolyte abnormalities are a consequence of traumatic brain injury (TBI), the degree to which electrolyte imbalances impact patient outcomes has not been fully established. We aim to determine the impact of sodium, potassium, calcium, and magnesium abnormalities on outcomes in patients with TBI. METHODS Four databases were searched for studies related to the impact of electrolyte abnormalities on outcomes for TBI patients. Outcomes of interest were rates of mortality, Glasgow Outcome Scale (GOS), and intensive care unit length of stay (ICU-LOS). The search included studies published up to July 21, 2022. Articles were then screened and included if they met inclusion and exclusion criteria. RESULTS In total, fourteen studies met inclusion and exclusion criteria for analysis in this systematic review. In patients with TBI, an increased mortality rate was associated with hypernatremia, hypokalemia, and hypocalcemia in the majority of studies. Both hyponatremia and hypomagnesemia were associated with worse GOS at 6 months. Whereas, both hyponatremia and hypernatremia were associated with increased ICU-LOS. There was no evidence to suggest other electrolyte imbalances were associated with either GOS or ICU-LOS. CONCLUSIONS Hyponatremia and hypomagnesemia were associated with worse GOS. Hypernatremia was associated with increased mortality and ICU-LOS. Hypokalemia and hypocalcemia were associated with increased mortality. Given these findings, future practice guidelines should consider the effects of electrolytes' abnormalities on outcomes in TBI patients prior to establishing management strategies.
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Affiliation(s)
- Micah Ngatuvai
- NOVA Southeastern University, Kiran Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Brian Martinez
- NOVA Southeastern University, Kiran Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Matthew Sauder
- NOVA Southeastern University, Kiran Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - George Beeton
- University of North Texas Health Science Center, Fort Worth, Texas
| | - Ryan Andrade
- A.T. Still University School of Osteopathic Medicine, Mesa, Arizona
| | - Piueti Maka
- John A. Burns School of Medicine, Honolulu, Hawaii
| | - Chadwick P Smith
- Division of Trauma and Surgical Critical Care, Department of Surgery, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida
| | - Lucy Kornblith
- Division of Trauma and Surgical Critical Care, Department of Surgery, Zuckerberg Hospital and Trauma Center, San Francisco, California
| | - Adel Elkbuli
- Division of Trauma and Surgical Critical Care, Department of Surgery, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida.
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Zhou Z, Huang C, Fu P, Huang H, Zhang Q, Wu X, Yu Q, Sun Y. Prediction of in-hospital hypokalemia using machine learning and first hospitalization day records in patients with traumatic brain injury. CNS Neurosci Ther 2022; 29:181-191. [PMID: 36258296 PMCID: PMC9804086 DOI: 10.1111/cns.13993] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/18/2022] [Accepted: 09/23/2022] [Indexed: 02/06/2023] Open
Abstract
AIMS Hypokalemia is a common complication following traumatic brain injury, which may complicate treatment and lead to unfavorable outcomes. Identifying patients at risk of hypokalemia on the first day of admission helps to implement prophylactic treatment, reduce complications, and improve prognosis. METHODS This multicenter retrospective study was performed between January 2017 and December 2020 using the electronic medical records of patients admitted due to traumatic brain injury. A propensity score matching approach was adopted with a ratio of 1:1 to overcome overfitting and data imbalance during subgroup analyses. Five machine learning algorithms were applied to generate a best-performed prediction model for in-hospital hypokalemia. The internal fivefold cross-validation and external validation were performed to demonstrate the interpretability and generalizability. RESULTS A total of 4445 TBI patients were recruited for analysis and model generation. Hypokalemia occurred in 46.55% of recruited patients and the incidences of mild, moderate, and severe hypokalemia were 32.06%, 12.69%, and 1.80%, respectively. Hypokalemia was associated with increased mortality, while severe hypokalemia cast greater impacts. The logistic regression algorithm had the best performance in predicting decreased serum potassium and moderate-to-severe hypokalemia, with an AUC of 0.73 ± 0.011 and 0.74 ± 0.019, respectively. The prediction model was further verified using two external datasets, including our previous published data and the open-assessed Medical Information Mart for Intensive Care database. Linearized calibration curves showed no statistical difference (p > 0.05) with perfect predictions. CONCLUSIONS The occurrence of hypokalemia following traumatic brain injury can be predicted by first hospitalization day records and machine learning algorithms. The logistic regression algorithm showed an optimal predicting performance verified by both internal and external validation.
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Affiliation(s)
- Zhengyu Zhou
- Department of Anesthesia, Huashan HospitalFudan UniversityShanghaiChina
| | - Chiungwei Huang
- Health Consultation and Physical Examination Center, Zhongshan HospitalFudan UniversityShanghaiChina,Department of Neurosurgery, Huashan Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Pengfei Fu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Hong Huang
- Information Center, Huashan HospitalFudan UniversityShanghaiChina
| | - Qi Zhang
- Information Center, Huashan HospitalFudan UniversityShanghaiChina
| | - Xuehai Wu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina,National Center for Neurological DisordersShanghaiChina,Shanghai Key Laboratory of Brain Function Restoration and Neural RegenerationShanghaiChina,Neurosurgical Institute of Fudan UniversityShanghaiChina,Shanghai Clinical Medical Center of NeurosurgeryShanghaiChina
| | - Qiong Yu
- Department of Anesthesia, Huashan HospitalFudan UniversityShanghaiChina
| | - Yirui Sun
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina,National Center for Neurological DisordersShanghaiChina,Shanghai Key Laboratory of Brain Function Restoration and Neural RegenerationShanghaiChina,Neurosurgical Institute of Fudan UniversityShanghaiChina,Shanghai Clinical Medical Center of NeurosurgeryShanghaiChina
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Schlögl M, Käch I, Beeler PE, Pape HC, Neuhaus V. Trauma patients with hypokalemia have an increased risk of morbidity and mortality. SURGERY IN PRACTICE AND SCIENCE 2021. [DOI: 10.1016/j.sipas.2021.100041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Shibata A, Matano F, Saito N, Fujiki Y, Matsumoto H, Mizunari T, Morita A. Serum Glucose-To-Potassium Ratio as a Prognostic Predictor for Severe Traumatic Brain Injury. J NIPPON MED SCH 2020; 88:342-346. [PMID: 32999180 DOI: 10.1272/jnms.jnms.2021_88-506] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Initial management of severe traumatic brain injury is important and includes treatment decision-making and prediction of prognosis. We examined whether biomarkers at admission could be useful prognostic predictors. We focused on electrolytes and blood glucose, which can be measured easily at any facility and for which results can be obtained promptly, before those of other biomarkers, such as D-dimer. METHODS All trauma patients with head injuries treated at Chiba Hokusoh Hospital between 2014 and 2017 were investigated. Cases of multiple trauma accompanied by fatal trauma, hemorrhagic shock, or cardiopulmonary arrest, and pediatric cases, were excluded from this study. Blood gas data at the initial hospital visit were reviewed retrospectively. A poor outcome was defined as death during hospitalization or a vegetative state due to head injury. Factors related to poor outcomes were analyzed. RESULTS Of the 185 male and 79 female patients studied, 34 had poor outcomes. Poor outcome was significantly correlated with potassium (P = 0.003), glucose (P < 0.001), and glucose-to-potassium ratio (P < 0.001) at arrival. The odds ratio was 4.079 for a glucose-to-potassium ratio of ≥50. CONCLUSIONS We evaluated blood gas data at the initial hospital visit, as these results can be obtained more quickly than those of other biomarkers assessed previously. Serum glucose-to-potassium ratio at admission may be a potential predictor of prognosis for severe traumatic brain injury.
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Affiliation(s)
- Ami Shibata
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Fumihiro Matano
- Department of Neurological Surgery, Nippon Medical School Hospital
| | - Nobuyuki Saito
- Department of Emergency and Critical Care Medicine Nippon Medical School, Chiba Hokusoh Hospital
| | - Yu Fujiki
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital
| | - Hisashi Matsumoto
- Department of Emergency and Critical Care Medicine Nippon Medical School, Chiba Hokusoh Hospital
| | - Takayuki Mizunari
- Department of Neurological Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School Hospital
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Kliś KM, Krzyżewski RM, Kwinta BM, Stachura K, Popiela TJ, Gąsowski J, Długopolski J. Relation of Intracerebral Hemorrhage Descriptors with Clinical Factors. Brain Sci 2020; 10:brainsci10040252. [PMID: 32344613 PMCID: PMC7226419 DOI: 10.3390/brainsci10040252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 11/16/2022] Open
Abstract
The association between intracerebral hemorrhage (ICH) shape and a poor treatment outcome has been established by few authors. We decided to analyze whether computationally assessed hemorrhage shape irregularity is associated with any known predictors of its poor treatment outcome. We retrospectively analyzed 48 patients with spontaneous intracerebral hemorrhage. For each patient we calculated Fractal Dimension, Compactness, Fourier Factor and Circle Factor. Our study showed that patients above 65 years old had significantly higher Compactness (0.70 ± 0.19 vs. 0.56 ± 0.20; p < 0.01), Fractal Dimension (0.46 ± 0.22 vs. 0.32 ± 0.20; p = 0.03) and Circle Factor (0.51 ± 0.25 vs. 0.35 ± 0.17; p < 0.01). Patients with hemorrhage growth had significantly higher Compactness (0.74 ± 0.23 vs. 0.58 ± 0.18; p < 0.01), Circle Factor (0.55 ± 0.27 vs. 0.37 ± 0.18; p < 0.01) and Fourier Factor (0.96 ± 0.06 vs. 0.84 ± 0.19; p = 0.03). In conclusion, irregularity resulting from the number of appendices can be a predictor of ICH growth; however, the size of those appendices is also important. Shape roughness better reflects the severity of brain tissue damage and a patient’s general condition.
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Affiliation(s)
- Kornelia M. Kliś
- Faculty of Medicine, Jagiellonian University Medical College, 31-008 Kraków, Poland;
- Faculty of Computer Science, Electronics and Telecommunications, AGH University of Science and Technology, 30-059 Kraków, Poland
- TENSOR - Team of NeuroSurgery-Oriented Research, Jagiellonian University Medical College, 31-008 Kraków, Poland;
| | - Roger M. Krzyżewski
- TENSOR - Team of NeuroSurgery-Oriented Research, Jagiellonian University Medical College, 31-008 Kraków, Poland;
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, 30-688 Kraków, Poland; (B.M.K.); (K.S.)
- Correspondence: ; Tel.: +48-12-4248662
| | - Borys M. Kwinta
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, 30-688 Kraków, Poland; (B.M.K.); (K.S.)
| | - Krzysztof Stachura
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, 30-688 Kraków, Poland; (B.M.K.); (K.S.)
| | - Tadeusz J. Popiela
- Department of Radiology, Jagiellonian University Medical College, 30-688 Kraków, Poland;
| | - Jerzy Gąsowski
- TENSOR - Team of NeuroSurgery-Oriented Research, Jagiellonian University Medical College, 31-008 Kraków, Poland;
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, 30-688 Kraków, Poland
| | - Jacek Długopolski
- Department of Computer Science, AGH University of Science and Technology, 30-059 Kraków, Poland;
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Zhou J, Yang CS, Shen LJ, Lv QW, Xu QC. Usefulness of serum glucose and potassium ratio as a predictor for 30-day death among patients with severe traumatic brain injury. Clin Chim Acta 2020; 506:166-171. [PMID: 32240656 DOI: 10.1016/j.cca.2020.03.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Serum glucose and potassium ratio (GPR) was recently found to be related to outcome of aneurysmal subarachnoid hemorrhage. This retrospectively study was to investigate the association of serum GPR with mortality in severe traumatic brain injury (sTBI). METHODS Clinical data were retrospectively reviewed of isolated sTBI patients admitted within 12 h after trauma between January 2014 and January 2019. We analyzed relationships between admission serum GPR and post-traumatic 30-day mortality in addition to admission Glasgow coma scale (GCS) scores. Discriminative ability was evaluated using area under receiver operating characteristic curve (AUC). RESULTS A total of 146 patients, of whom 37 (25.3%) died within 30 days following trauma, were included. Admission serum GPR emerged as an independent predictor for 30-day mortality (odds ratio, 5.256; 95% confidence interval (CI), 1.111-14.856) and overall survival (hazard ratio, 4.822; 95% CI, 1.157-12.870), with an AUC of 0.777 (95% CI, 0.693-0.835), which was equivalent to that of GCS scores (AUC, 0.831; 95% CI, 0.760-0.888; P = 0.179). There was a significant correlation between admission serum GPR and GCS scores (r2 = 0.293). CONCLUSIONS Serum GPR in cases of sTBI is substantially associated with trauma severity and 30-day mortality. Therefore, the potential value of serum GPR for predicting short-term mortality of sTBI patients is favorable.
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Affiliation(s)
- Jing Zhou
- Department of Neurosurgery, Shengzhou People's Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch), No. 666 Dangui Road, Shengzhou 312400, Zhejiang, China
| | - Chun-Song Yang
- Department of Neurosurgery, Shengzhou People's Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch), No. 666 Dangui Road, Shengzhou 312400, Zhejiang, China.
| | - Liang-Jun Shen
- Department of Neurosurgery, Shengzhou People's Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch), No. 666 Dangui Road, Shengzhou 312400, Zhejiang, China
| | - Qing-Wei Lv
- Department of Neurosurgery, Shengzhou People's Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch), No. 666 Dangui Road, Shengzhou 312400, Zhejiang, China
| | - Qi-Chen Xu
- Department of Neurosurgery, Shengzhou People's Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch), No. 666 Dangui Road, Shengzhou 312400, Zhejiang, China
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10
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Taniguchi H, Doi T, Abe T, Takeuchi I. Trauma severity associated with stress index in emergency settings: an observational prediction-and-validation study. Acute Med Surg 2020; 7:e493. [PMID: 33391764 PMCID: PMC7774291 DOI: 10.1002/ams2.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/23/2020] [Accepted: 02/05/2020] [Indexed: 11/23/2022] Open
Abstract
Aim Early judgments for treating severe trauma patients are essential for life‐saving. Stress index (SI), obtained from a division of blood glucose level by serum potassium at arrival, might be useful for early prediction. However, the efficacy of SI was unknown. The purpose of this study was to identify and validate prediction models of severe trauma (ST) and the need for damage control operation (DCOP) and massive transfusion (MT) by using SI among trauma patients. Methods This study was a retrospective and prospective observational study. The prediction models were created by 1‐year retrospective data of 167 trauma patients. The prediction models were validated by 6 months of prospective data of 87 trauma patients. Results The prediction model for ST contained respiratory rate and SI as significant factors. The prediction model for DCOP contained SI. The prediction model for MT contained systolic blood pressure and SI. The correlation of probability of MT, ST, and DCOP was r = 0.70 (P < 0.001), r = 0.46 (P < 0.001), and r = 0.15 (P = 0.196), respectively. The predicted probability of MT, ST, and DCOP showed 0.93 (95% confidence interval [CI], 0.88–0.90) and 0.80 (95% CI, 0.74–0.86), and 0.79 (95% CI, 0.70–0.88). Conclusion We identified and validated our prediction models for ST and the need for DCOP and MT among trauma patients using SI as a main predictor. Our models indicated that fewer variables in an early phase of the treatment process can inform clinicians regarding how severe a patient is and which intervention is needed.
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Affiliation(s)
- Hayato Taniguchi
- Department of Emergency and Critical Care Medicine Yokosuka Kyousai Hospital Yokosuka Japan.,Department of Emergency Medicine Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Tomoki Doi
- Department of Emergency and Critical Care Medicine Yokosuka Kyousai Hospital Yokosuka Japan.,Department of Emergency Medicine Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Takeru Abe
- Department of Emergency Medicine Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Ichiro Takeuchi
- Department of Emergency Medicine Yokohama City University Graduate School of Medicine Yokohama Japan
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Nordström T, Andersson LC, Åkerman KE. Regulation of intracellular pH by electrogenic Na+/HCO3– co-transporters in embryonic neural stem cell-derived radial glia-like cells. BIOCHIMICA ET BIOPHYSICA ACTA-BIOMEMBRANES 2019; 1861:1037-1048. [DOI: 10.1016/j.bbamem.2019.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/11/2019] [Accepted: 03/14/2019] [Indexed: 01/19/2023]
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12
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Effect of Age on Glasgow Coma Scale in Patients with Moderate and Severe Traumatic Brain Injury: An Approach with Propensity Score-Matched Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14111378. [PMID: 29137197 PMCID: PMC5708017 DOI: 10.3390/ijerph14111378] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/09/2017] [Accepted: 11/11/2017] [Indexed: 12/29/2022]
Abstract
Background: The most widely used methods of describing traumatic brain injury (TBI) are the Glasgow Coma Scale (GCS) and the Abbreviated Injury Scale (AIS). Recent evidence suggests that presenting GCS in older patients may be higher than that in younger patients for an equivalent anatomical severity of TBI. This study aimed to assess these observations with a propensity-score matching approach using the data from Trauma Registry System in a Level I trauma center. Methods: We included all adult patients (aged ≥20 years old) with moderate to severe TBI from 1 January 2009 to 31 December 2016. Patients were categorized into elderly (aged ≥65 years) and young adults (aged 20–64 years). The severity of TBI was defined by an AIS score in the head (AIS 3‒4 and 5 indicate moderate and severe TBI, respectively). We examined the differences in the GCS scores by age at each head AIS score. Unpaired Student’s t- and Mann–Whitney U-tests were used to analyze normally and non-normally distributed continuous data, respectively. Categorical data were compared using either the Pearson chi-square or two-sided Fisher’s exact tests. Matched patient populations were allocated in a 1:1 ratio according to the propensity scores calculated using NCSS software with the following covariates: sex, pre-existing chronic obstructive pulmonary disease, systolic blood pressure, hemoglobin, sodium, glucose, and alcohol level. Logistic regression was used to evaluate the effects of age on the GCS score in each head AIS stratum. Results: The study population included 2081 adult patients with moderate to severe TBI. These patients were categorized into elderly (n = 847) and young adults (n = 1234): each was exclusively further divided into three groups of patients with head AIS of 3, 4, or 5. In the 162 well-balanced pairs of TBI patients with head AIS of 3, the elderly demonstrated a significantly higher GCS score than the young adults (14.1 ± 2.2 vs. 13.1 ± 3.3, respectively; p = 0.002). In the 362 well-balanced pairs of TBI patients with head AIS of 4, the elderly showed a significantly higher GCS score than the young adults (13.1 ± 3.3 vs. 12.2 ± 3.8, respectively; p = 0.002). In the 89 well-balance pairs of TBI patients with head AIS of 5, no significant differences were observed for the GCS scores. Conclusions: This study demonstrated that elderly patients with moderate TBI present higher GCS score than younger patients. This study underscores the importance of determining of TBI severity in this group of elderly patients based on the GCS score alone. A lower threshold of GCS cutoff should be adopted in the management of the elderly patients with TBI.
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Hifumi T, Kuroda Y, Kawakita K, Yamashita S, Oda Y, Dohi K, Maekawa T. Plasma Potassium Concentration on Admission Correlates with Neurologic Outcome in Traumatic Brain Injury Patients Treated with Targeted Temperature Management: A Post Hoc Analysis of a Multicenter Randomized Controlled Trial. World Neurosurg 2016; 94:437-441. [PMID: 27450973 DOI: 10.1016/j.wneu.2016.07.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/09/2016] [Accepted: 07/11/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recent studies have focused on the association between plasma electrolytes, particularly potassium level and neurologic outcomes in patients with traumatic brain injury (TBI). We hypothesized that potassium level on admission is an indicator for initiation of targeted temperature management in patients with severe TBI. METHODS We re-evaluated the Brain Hypothermia Study data based on the potassium levels on admission (i.e., hypokalemia [<3.5 mEq/L] or normokalemia [3.5-5 mEq/L]) and compared these values and Glasgow Outcome Scale scores at 6 months by per protocol analysis. Consequently, 135 patients were enrolled. Finally, groups 50 and 23 patients with hypokalemia and 34 and 23 patients with normokalemia were allocated to mild therapeutic hypothermia (MTH) and fever control groups, respectively. Baseline characteristics, complication rates, and favorable neurologic outcome rates were compared between the two groups. RESULTS In the normokalemia patients, fever control management was associated with a significant increase in favorable neurologic outcome compared with those in the MTH group (68.2% vs. 35.3%; P = 0.03). The complication rate was significantly higher in the MTH group than in the fever control group for patients with normokalemia (23.4% vs. 0%; P = 0.03). Conversely, hypokalemia patients in the MTH group revealed relatively better favorable neurologic outcomes compared with those in the fever control group (52.0% vs. 39.1%; P = 0.33). CONCLUSIONS The initial potassium level may be an indicator in determining appropriate targeted temperature management for patients with TBI. Fever control may be considered instead of MTH for normokalemia patients with TBI on admission.
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Affiliation(s)
- Toru Hifumi
- Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, Kagawa, Japan.
| | - Yasuhiro Kuroda
- Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, Kagawa, Japan
| | - Kenya Kawakita
- Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, Kagawa, Japan
| | - Susumu Yamashita
- Department of Emergency Medicine, Tokuyama Central Hospital, Yamaguchi, Japan
| | - Yasutaka Oda
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Kenji Dohi
- Department of Emergency Medicine, School of Medicine, Jikei University, Tokyo, Japan
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Abstract
Alkali metals, especially sodium and potassium, are plentiful and vital in biological systems. They take on important roles in health and disease. Such roles include the regulation of homeostasis, osmosis, blood pressure, electrolytic equilibria, and electric current. However, there is a limit to our present understanding; the ions have a great ability and capacity for action in health and disease, much greater than our current understanding. For the regulation of physiological homeostasis, there is a crucial regulator (renin-angiotensin system, RAS), found at both peripheral and central levels. Misregulation of the Na(+)-K(+) pump, and sodium channels in RAS are important for the understanding of disease progression, hypertension, diabetes, and neurodegenerative diseases, etc. In particular, RAS displays direct or indirect interaction important to Parkinson's disease (PD). In this chapter, the relationship between the regulation of sodium/potassium concentration and PD was sought. In addition, some recent biochemical and clinical findings are also discussed that help describe sodium and potassium in the context of traumatic brain injury (TBI). TBI is caused from the heavy striking of the head; this strongly affects ion flux in the affected tissue (brain) and damages cellular regulation systems. Thus, inappropriate concentrations of ions (hyper- and hyponatremia, and hyper- and hypokalemia) will perturb homeostasis giving rise to important and far reaching effects. These changes also impact osmotic pressure and the concentration of other metal ions, such as the calcium(II) ion.
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Ookuma T, Miyasho K, Kashitani N, Beika N, Ishibashi N, Yamashita T, Ujike Y. The clinical relevance of plasma potassium abnormalities on admission in trauma patients: a retrospective observational study. J Intensive Care 2015; 3:37. [PMID: 26269745 PMCID: PMC4534081 DOI: 10.1186/s40560-015-0103-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 08/02/2015] [Indexed: 11/29/2022] Open
Abstract
Background Abnormalities in potassium levels can lead to several clinical difficulties in trauma patients admitted to the ICU. However, the significance of potassium abnormalities soon after admission in trauma patients has not yet been clearly delineated. The objective of this study was to describe the plasma potassium abnormalities in trauma patients on admission and to examine the clinical outcomes associated with these abnormalities. Methods We performed a retrospective observational study of plasma potassium levels in trauma patients admitted to the Fukuyama City Hospital between January 1, 2010 and December 31, 2013. Five hundred twenty consecutive trauma patients were included and categorized into six groups according to their plasma potassium level on admission (<3.0, 3.0–<3.5, 3.5–<4.0, 4.0–<4.5, 4.5–<5.0, and ≥5.0 mEq/L). After adjusting for covariates, including age, gender, the Revised Trauma Score, and the Injury Severity Score, logistic regression analysis was used to examine the association between plasma potassium levels and outcomes, including life-saving interventions and in-hospital mortality. Results Two hundred twenty-seven patients (43.7 %) presented with hypokalemia (<3.5 mEq/L), while seven patients (1.3 %) presented with hyperkalemia (≥5.0 mEq/L). Patients in the lowest potassium group (<3.0 mEq/L, n = 36 [6.9 %]) were significantly associated with craniotomy (adjusted odds ratio 5.25 [95 % confidence interval 2.06–13.40]; p < 0.001) and showed an increased trend toward in-hospital mortality. In the second lowest potassium group (3.0–< 3.5 mEq/L, n = 191 [36.7 %]), the adjusted odds ratio for craniotomy was significantly higher (2.03 [95 % confidence interval 1.01–4.07]; p = 0.048) compared to the reference group. Conclusions Trauma patients presenting with hypokalemia (<3.5 mEq/L) on admission may be associated with severe head trauma requiring life-saving craniotomy.
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Affiliation(s)
- Takaaki Ookuma
- Fukuyama City Hospital Emergency Medical Center, 5-23-1 Zaocho, Fukuyama, Hiroshima 721-8511 Japan
| | - Koji Miyasho
- Fukuyama City Hospital Emergency Medical Center, 5-23-1 Zaocho, Fukuyama, Hiroshima 721-8511 Japan
| | - Nobuhiro Kashitani
- Fukuyama City Hospital Emergency Medical Center, 5-23-1 Zaocho, Fukuyama, Hiroshima 721-8511 Japan
| | - Nobuhiko Beika
- Fukuyama City Hospital Emergency Medical Center, 5-23-1 Zaocho, Fukuyama, Hiroshima 721-8511 Japan
| | - Naoki Ishibashi
- Fukuyama City Hospital Emergency Medical Center, 5-23-1 Zaocho, Fukuyama, Hiroshima 721-8511 Japan
| | - Takahiro Yamashita
- Fukuyama City Hospital Emergency Medical Center, 5-23-1 Zaocho, Fukuyama, Hiroshima 721-8511 Japan
| | - Yoshihito Ujike
- Department of Emergency and Critical Care Medicine, Field of Functional Physiology, Branch of Biophysiological Science, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, 700-8558 Japan
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