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Lanzilao L, Bianchi I, Grassi S, Defraia B, Brogi M, Da Ros M, Biagioli T, Fanelli A, Pinchi V, Focardi M. Biomarkers of traumatic brain injury in vitreous humor: A pilot study. Forensic Sci Int 2023; 350:111782. [PMID: 37467521 DOI: 10.1016/j.forsciint.2023.111782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/18/2023] [Accepted: 07/02/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) is one of the major causes of morbidity and mortality worldwide. The patients' and injuries' heterogeneity associated with TBI, alongside with its variable clinical manifestations, make it challenging to make diagnosis and predict prognosis. Therefore, the identification of reliable prognostic markers would be relevant both to support clinical decision-making and forensic evaluation of polytraumatic deaths and cases of medical malpractice. This pilot study aimed to evaluate some of the main biomarkers specific for brain damage in sTBI and mmTBI deaths in samples of vitreous humor (VH) in order to verify whether predictors of prognosis in TBI can be found in this matrix. METHODS VH were obtained from both eyes (right and left) of 30 cadavers (20 sTBI and 10 mmTBI) and analysed. These factors were evaluated: NSE (neuron-specific enolase), S100 calcium-binding protein (S100), glial fibrillary acidic protein (GFAP), Brain-derived neurotrophic factor (BDNF), Copeptin, Interleukin 6 (IL-6), Ferritin, Lactate dehydrogenase (LDH), C-Reactive Protein (CRP), Procalcitonin (PCT), Glucose and Neutrophil gelatinase-associated lipocalin (N-Gal). RESULTS Four of the analysed proteins (LDH, ferritin, S100 and NSE) proved to be particularly promising. In particular, logistic regression analysis found a good discriminatory power. CONCLUSIONS Given the peculiarity of the matrix and the poor standardization of the sampling, such promising results need to be furtherly investigated in serum before being implemented in the forensic practice.
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Affiliation(s)
- Luisa Lanzilao
- Biochemestry laboratory, Department of Diagnostics, Careggi Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Ilenia Bianchi
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; Laboratory of Personal Identification and Forensic Morphology, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Simone Grassi
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; Laboratory of Personal Identification and Forensic Morphology, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy.
| | - Beatrice Defraia
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; Laboratory of Personal Identification and Forensic Morphology, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Marco Brogi
- Biochemestry laboratory, Department of Diagnostics, Careggi Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Martina Da Ros
- Biochemestry laboratory, Department of Diagnostics, Careggi Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Tiziana Biagioli
- Biochemestry laboratory, Department of Diagnostics, Careggi Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Alessandra Fanelli
- Biochemestry laboratory, Department of Diagnostics, Careggi Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Vilma Pinchi
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; Laboratory of Personal Identification and Forensic Morphology, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Martina Focardi
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; Laboratory of Personal Identification and Forensic Morphology, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
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Cavalli I, Stella C, Stoll T, Mascia L, Salvagno M, Coppalini G, Diosdado A, Menozzi M, Diaferia D, Ndieugnou Djangang N, Oliveira F, Schuind S, Taccone FS, Gouvêa Bogossian E. Serum LDH levels may predict poor neurological outcome after aneurysmal subarachnoid hemorrhage. BMC Neurol 2023; 23:228. [PMID: 37312033 PMCID: PMC10262567 DOI: 10.1186/s12883-023-03282-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/07/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Serum lactate dehydrogenase (LDH) levels are often elevated in cardiovascular diseases. Their prognostic role after subarachnoid hemorrhage (SAH) remains poorly evaluated. METHODS This is a retrospective single-center study of patients with non-traumatic SAH admitted to the intensive care unit (ICU) of an University Hospital from 2007 to 2022. Exclusion criteria were pregnancy and incomplete medical records or follow-up data. Baseline information, clinical data, radiologic data, the occurrence of neurological complications as well as serum LDH levels during the first 14 days of ICU stay were collected. Unfavorable neurological outcome (UO) at 3 months was defined as a Glasgow Outcome Scale of 1-3. RESULTS Five hundred and forty-seven patients were included; median serum LDH values on admission and the highest LDH values during the ICU stay were 192 [160-230] IU/L and 263 [202-351] IU/L, respectively. The highest LDH value was recorded after a median of 4 [2-10] days after ICU admission. LDH levels on admission were significantly higher in patients with UO. When compared with patients with favorable outcome (FO), patients with UO had higher serum LDH values over time. In the multivariate logistic regression model, the highest LDH value over the ICU stay (OR 1.004 [95% CI 1.002 - 1.006]) was independently associated with the occurrence of UO; the area under the receiving operator (AUROC) curve for the highest LDH value over the ICU stay showed a moderate accuracy to predict UO (AUC 0.76 [95% CI 0.72-0.80]; p < 0.001), with an optimal threshold of > 272 IU/L (69% sensitivity and 74% specificity). CONCLUSIONS The results in this study suggest that high serum LDH levels are associated with the occurrence of UO in SAH patients. As a readily and available biomarker, serum LDH levels should be evaluated to help with the prognostication of SAH patients.
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Affiliation(s)
- Irene Cavalli
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 8081070, Brussels, Belgium
- Department Medical and Surgical Science, Unit of Anesthesia and Intensive Care Medicine, Policlinico Di Sant'Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Claudia Stella
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 8081070, Brussels, Belgium
| | - Timothée Stoll
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 8081070, Brussels, Belgium
| | - Luciana Mascia
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Michele Salvagno
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 8081070, Brussels, Belgium
| | - Giacomo Coppalini
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 8081070, Brussels, Belgium
| | - Alberto Diosdado
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 8081070, Brussels, Belgium
| | - Marco Menozzi
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 8081070, Brussels, Belgium
| | - Daniela Diaferia
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 8081070, Brussels, Belgium
| | - Narcisse Ndieugnou Djangang
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 8081070, Brussels, Belgium
| | - Fernando Oliveira
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 8081070, Brussels, Belgium
| | - Sophie Schuind
- Department of Neurosurgery, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 8081070, Brussels, Belgium
| | - Elisa Gouvêa Bogossian
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik, 8081070, Brussels, Belgium.
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Sivashankar S A, Swamiyappan SS, Visweswaran V, Bathala RT, Krishnaswamy V, Davuluri VS, Sridhar A, K G. Biochemical and Radiological Factors for Prognostication of Traumatic Brain Injury: An Institutional Experience. Cureus 2023; 15:e40999. [PMID: 37503475 PMCID: PMC10371385 DOI: 10.7759/cureus.40999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
Introduction Traumatic brain injury (TBI) necessitates identifying patients at risk of fatal outcomes. Classic biomarkers used clinically today in other organ systems are quantitative in nature. This aspect largely restricts the prognostic ability of a theoretical quantitative brain biomarker. This study aimed to explore biochemical markers and imaging findings reflecting the severity of cerebral damage to predict outcomes. Methodology In this study, 61 TBI cases with moderate to severe brain injury were prospectively observed, and various indices including random blood sugar (RBS), hemoglobin, international normalized ratio (INR), lactate dehydrogenase (LDH), cortisol, and CT findings were assessed. Glasgow Outcome Scores (GOS) determined the outcomes. Statistical analysis was carried out to assess correlations. Results The mean RBS level of those who did not survive was 259.58 mg/dL, whereas in those who survived the value was 158.48 mg/dL. Analysis indicated that patients with high RBS value on admission had a higher risk of mortality (p=0.000). We noted that the mean serum cortisol levesl on both Days 1 and 5 were higher in patients who died and were able to establish a statistically significant correlation between both the values and outcome. A statistically significant negative correlation between Day 1 and Day 5 serum LDH levels and outcomes was evident from our study (p=0.000 for both). Among the components of the Rotterdam score, the presence of intraventricular hemorrhage (IVH) in the CT scan had a significant association with unfavorable outcomes (p=0.01) while midline shift was significantly associated with a low GCS (p=0.04). Conclusion Biochemical markers such as INR, RBS, serum cortisol, and LDH at admission can serve as valuable indicators of prognosis in TBI patients. Furthermore, a persistent increase in LDH and cortisol levels between Days 1 and 5, along with the Glasgow Coma Scale and Rotterdam Scoring system, are good predictors of mortality.
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Affiliation(s)
- Abinav Sivashankar S
- Neurological Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | | | - Vivek Visweswaran
- Neurological Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Rav Tej Bathala
- Neurosurgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | | | | | - Ashwin Sridhar
- Neurological Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Ganesh K
- Neurological Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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Dzierzęcki S, Ząbek M, Zapolska G, Tomasiuk R. The S-100B level, intracranial pressure, body temperature, and transcranial blood flow velocities predict the outcome of the treatment of severe brain injury. Medicine (Baltimore) 2022; 101:e30348. [PMID: 36197246 PMCID: PMC9509168 DOI: 10.1097/md.0000000000030348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This study evaluates the applicability of S100B levels, mean maximum velocity (Vmean) over time, pulsatility index (PI), intracranial pressure (ICP), and body temperature (T) for the prediction of the treatment of patients with traumatic brain injury (TBI). Sixty patients defined by the Glasgow Coma Scale score ≤ 8 were stratified using the Glasgow Coma Scale into 2 groups: favorable (FG: Glasgow Outcome Scale ≥ 4) and unfavorable (UG: Glasgow Outcome Scale < 4). The S100B concentration was at the time of hospital admission. Vmean was measured using transcranial Doppler. PI was derived from a transcranial Doppler examination. T was measured in the temporal artery. The differences in mean between FG and UG were tested using a bootstrap test of 10,000 repetitions with replacement. Changes in S100B, Vmean, PI, ICP, and T levels stratified by the group were calculated using the one-way aligned rank transform for nonparametric factorial analysis of variance. The reference ranges for the levels of S100B, Vmean, and PI were 0.05 to 0.23 µg/L, 30.8 to 73.17 cm/s, and 0.62 to 1.13, respectively. Both groups were defined by an increase in Vmean, a decrease in S100B, PI, and ICP levels; and a virtually constant T. The unfavorable outcome is defined by significantly higher levels of all parameters, except T. A favorable outcome is defined by S100B < 3 mg/L, PI < 2.86, ICP > 25 mm Hg, and Vmean > 40 cm/s. The relationships provided may serve as indicators of the results of the TBI treatment.
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Affiliation(s)
- Sebastian Dzierzęcki
- Department of Neurosurgery, Postgraduate Medical Centre, Warsaw, Poland
- Gamma Knife Centre, Brodno Masovian Hospital, Warsaw, Poland
- *Correspondence: Sebastian Dzierzecki, Warsaw Gamma Knife Centre, Brodno Masovian Hospital, Kondratowicza 8 Building H, 03-242 Warsaw, Poland (e-mail: )
| | - Mirosław Ząbek
- Department of Neurosurgery, Postgraduate Medical Centre, Warsaw, Poland
- Clinical Department of Neurosurgery, Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland
| | | | - Ryszard Tomasiuk
- Kazimierz Pulaski University of Technology and Humanities Radom, Faculty of Medical Sciences and Health Sciences, Radom, Poland
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Zan X, Deng H, Zhang Y, Wang P, Chong W, Hai Y, You C, Fang F. Lactate dehydrogenase predicting mortality in patients with aneurysmal subarachnoid hemorrhage. Ann Clin Transl Neurol 2022; 9:1565-1573. [PMID: 35984334 PMCID: PMC9539376 DOI: 10.1002/acn3.51650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/23/2022] [Accepted: 07/14/2022] [Indexed: 11/22/2022] Open
Abstract
Objective Lactate dehydrogenase (LDH) has been reported to be associated with outcomes after surgery in patients with aneurysmal subarachnoid hemorrhage (aSAH), but it is unclear if this is independent from other biomarkers and across all aSAH treatments. This study aims to assess whether LDH is an independent predictor of mortality in patients with aSAH and test whether the inclusion of LDH in a well‐established prediction model can improve discrimination and reclassification. Methods This was a retrospective observational study at a tertiary academic medical center. This study measured baseline LDH levels taken at admission and longitudinal LDH levels (up to a month postadmission) to assess median, max, and trajectory LDH levels. The primary outcome was mortality at 90 days. Multivariable regression analyses were used to evaluate associations between LDH and outcomes. The full original Subarachnoid Hemorrhage International Trialists' (SAHIT) model was used as the reference model. Results In total, 3524 patients with aSAH were included. LDH at admission was independently associated with mortality at 90 days (quartile 4 vs. 1: odds ratio 1.60; 95% CI 1.08–2.37) and mortality at the longest follow‐up (quartile 4 vs. 1: hazard ratio1.72; 95% CI 1.34–2.20). Compared with the SAHIT model, the addition of three LDH (admission, max, and median) levels to the SAHIT model significantly improved the area under the curve and categorical net reclassification improvement for prediction mortality. Interpretation In patients with aSAH, LDH level is an independent predictor of all‐cause mortality. The incorporation of LDH into a well‐established prediction model improved the ability to predict the risk of death in patients with aSAH.
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Affiliation(s)
- Xin Zan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Haidong Deng
- Center for Evidence Based Medical, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Yu Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Center for Evidence Based Medical, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Peng Wang
- Center for Evidence Based Medical, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Weelic Chong
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yang Hai
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fang Fang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Zheng S, Zhang Y, Wang H, Xie X, Lin Y, Yao P, Lin Z, Kang D. Serum Lactate Dehydrogenase to Phosphate Ratio as an Independent Predictor for Adverse Outcome of Microsurgical Clipping for Ruptured Intracranial Aneurysm: A Propensity-Score Matching Analysis. Brain Sci 2022; 12:brainsci12060737. [PMID: 35741622 PMCID: PMC9220933 DOI: 10.3390/brainsci12060737] [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: 04/20/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: In this study, we assessed the correlation between the lactate dehydrogenase (LDH) to phosphate ratio and the prognosis of microsurgical clippings for ruptured intracranial aneurysm (rIA) to test the hypothesis that the serum LDH to phosphate ratio could be a predictor of the outcome of microsurgical clipping for rIA. Methods: Records of rIA patients between 2012 and 2018 were retrospectively collected. Age, sex, Hunt-Hess grade, Fisher grade, medical history, aneurysm location, hydrocephalus, laboratory data including serum LDH, phosphate, and LDH to phosphate ratio, related complications, and the outcomes in 3 months were recorded. Results: A total of 1608 rIA patients in our institution were collected, and 856 patients treated by microsurgical clipping were enrolled. On admission, a significantly higher LDH-phosphate ratio was observed in patients with poor outcomes at 3 months (median ± SD, 200.175 ± 107.290 for mRS 0−2 vs. 323.826 ± 219.075 for mRS score 3−6; p = 0.000). An LDH to phosphate ratio of 226.25 in the receiver operating characteristic (ROC) curve was the optimal cutoff value to discriminate between good and poor outcomes at 3 months. The LDH to phosphate ratio ≥ 226.25 on admission was independently correlated with poor outcomes in rIA patients. In addition, Hunt and Hess grade, Fisher grade, pneumonia, and DIND were also independently correlated with poor outcomes. After removing the bias in essential clinical variables between patients with LDH to phosphate, ratio ≥ 226.25 versus <226.25 by PSM, the number of patients with poor outcomes at 3 months increased in patients with an LDH to phosphate ratio of ≥226.25 (p = 0.005). Conclusions: The LDH to phosphate ratio was a potential biomarker and could predict the unfavorable outcome of microsurgical clipping for rIA in 3 months, related to neuronal damage, cerebral hypoxia, and early brain injury after aneurysm ruptures.
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Affiliation(s)
- Shufa Zheng
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, China; (S.Z.); (Y.Z.); (H.W.); (X.X.); (Y.L.); (P.Y.); (Z.L.)
| | - Yibin Zhang
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, China; (S.Z.); (Y.Z.); (H.W.); (X.X.); (Y.L.); (P.Y.); (Z.L.)
| | - Haojie Wang
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, China; (S.Z.); (Y.Z.); (H.W.); (X.X.); (Y.L.); (P.Y.); (Z.L.)
| | - Xueling Xie
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, China; (S.Z.); (Y.Z.); (H.W.); (X.X.); (Y.L.); (P.Y.); (Z.L.)
| | - Yuanxiang Lin
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, China; (S.Z.); (Y.Z.); (H.W.); (X.X.); (Y.L.); (P.Y.); (Z.L.)
| | - Peisen Yao
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, China; (S.Z.); (Y.Z.); (H.W.); (X.X.); (Y.L.); (P.Y.); (Z.L.)
| | - Zhangya Lin
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, China; (S.Z.); (Y.Z.); (H.W.); (X.X.); (Y.L.); (P.Y.); (Z.L.)
| | - Dezhi Kang
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, China; (S.Z.); (Y.Z.); (H.W.); (X.X.); (Y.L.); (P.Y.); (Z.L.)
- Fujian Provincial Clinical Research Center for Neurological Disease, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, China
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, China
- Fujian Provincial Institutes of Brain Disorders and Brain Sciences, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, China
- Clinical Research and Translation Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, China
- The First Affiliated Hospital, Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou 350004, China
- Correspondence: ; Tel.: +86-138-5909-9988; Fax: +86-591-83569369
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Forensic biomarkers of lethal traumatic brain injury. Int J Legal Med 2022; 136:871-886. [PMID: 35226180 PMCID: PMC9005436 DOI: 10.1007/s00414-022-02785-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/21/2022] [Indexed: 11/01/2022]
Abstract
AbstractTraumatic brain injury (TBI) is a major cause of death and its accurate diagnosis is an important concern of daily forensic practice. However, it can be challenging to diagnose TBI in cases where macroscopic signs of the traumatic head impact are lacking and little is known about the circumstances of death. In recent years, several post-mortem studies investigated the possible use of biomarkers for providing objective evidence for TBIs as the cause of death or to estimate the survival time and time since death of the deceased. This work systematically reviewed the available scientific literature on TBI-related biomarkers to be used for forensic purposes. Post-mortem TBI-related biomarkers are an emerging and promising resource to provide objective evidence for cause of death determinations as well as survival time and potentially even time since death estimations. This literature review of forensically used TBI-biomarkers revealed that current markers have low specificity for TBIs and only provide limited information with regards to survival time estimations and time since death estimations. Overall, TBI fatality-related biomarkers are largely unexplored in compartments that are easily accessible during autopsies such as urine and vitreous humor. Future research on forensic biomarkers requires a strict distinction of TBI fatalities from control groups, sufficient sample sizes, combinations of currently established biomarkers, and novel approaches such as metabolomics and mi-RNAs.
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Wang CY, Zhang YB, Wang JQ, Zhang XT, Pan ZM, Chen LX. Association Between Serum Lactate Dehydrogenase Level and Hematoma Expansion in Patients with Primary Intracerebral Hemorrhage: A Propensity-Matched Analysis. World Neurosurg 2022; 160:e579-e590. [DOI: 10.1016/j.wneu.2022.01.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/26/2022]
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Tomasiuk R, Dzierzęcki S, Zaczyński A, Ząbek M. Usability of the Level of the S100B Protein, the Gosling Pulsatility Index, and the Jugular Venous Oxygen Saturation for the Prediction of Mortality and Morbidity in Patients with Severe Traumatic Brain Injury. BIOMED RESEARCH INTERNATIONAL 2021; 2021:2398488. [PMID: 34734081 PMCID: PMC8560266 DOI: 10.1155/2021/2398488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/16/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022]
Abstract
The high frequency of traumatic brain injury imposes severe economic stress on health and insurance services. The objective of this study was to analyze the association between the serum S100B protein, the Gosling pulsatility index (PI), and the level of oxygen saturation at the tip of the internal jugular vein (SjVO2%) in patients diagnosed with severe TBI. The severity of TBI was assessed by a GCS score ≤ 8 stratified by Glasgow outcome scale (GOS) measured on the day of discharge from the hospital. Two groups were included: GOS < 4 (unfavorable group (UG)) and GOS ≥ 4 (favorable group (UG)). S100B levels were higher in the UG than in the FG. PI levels in the UG were also substantially higher than in the FG. There were similar levels of SjVO2 in the two groups. This study confirmed that serum S100B levels were higher in patients with unfavorable outcomes than in those with favorable outcomes. Moreover, a clear demarcation in PI between unfavorable and FGs was observed. This report shows that mortality and morbidity rates in patients with traumatic brain injury can be assessed within the first 4 days of hospitalization using the S100B protein, PI values, and SjVO2.
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Affiliation(s)
- Ryszard Tomasiuk
- Kazimierz Pulaski University of Technology and Humanities Radom, Faculty of Medical Sciences and Health Sciences, Radom, Poland
| | - Sebastian Dzierzęcki
- Department of Neurosurgery, Postgraduate Medical Centre, Warsaw, Poland
- Gamma Knife Centre, Brodno Masovian Hospital, Warsaw, Poland
| | - Artur Zaczyński
- Clinical Department of Neurosurgery, Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland
| | - Mirosław Ząbek
- Department of Neurosurgery, Postgraduate Medical Centre, Warsaw, Poland
- Gamma Knife Centre, Brodno Masovian Hospital, Warsaw, Poland
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Krausz AD, Korley FK, Burns MA. The Current State of Traumatic Brain Injury Biomarker Measurement Methods. BIOSENSORS 2021; 11:319. [PMID: 34562909 PMCID: PMC8469272 DOI: 10.3390/bios11090319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 12/16/2022]
Abstract
Traumatic brain injury (TBI) is associated with high rates of morbidity and mortality partially due to the limited tools available for diagnosis and classification. Measuring panels of protein biomarkers released into the bloodstream after injury has been proposed to diagnose TBI, inform treatment decisions, and monitor the progression of the injury. Being able to measure these protein biomarkers at the point-of-care would enable assessment of TBIs from the point-of-injury to the patient's hospital bedside. In this review, we provide a detailed discussion of devices reported in the academic literature and available on the market that have been designed to measure TBI protein biomarkers in various biofluids and contexts. We also assess the challenges associated with TBI biomarker measurement devices and suggest future research directions to encourage translation of these devices to clinical use.
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Affiliation(s)
- Alyse D. Krausz
- Biomedical Engineering Department, University of Michigan, Ann Arbor, MI 48109, USA
| | - Frederick K. Korley
- Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Mark A. Burns
- Biomedical Engineering Department, University of Michigan, Ann Arbor, MI 48109, USA
- Chemical Engineering Department, University of Michigan, Ann Arbor, MI 48109, USA
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Zheng S, Wang H, Chen G, Shangguan H, Yu L, Lin Z, Lin Y, Yao P, Kang D. Higher Serum Levels of Lactate Dehydrogenase Before Microsurgery Predict Poor Outcome of Aneurysmal Subarachnoid Hemorrhage. Front Neurol 2021; 12:720574. [PMID: 34456854 PMCID: PMC8387557 DOI: 10.3389/fneur.2021.720574] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/19/2021] [Indexed: 02/03/2023] Open
Abstract
Introduction: We explored whether higher preoperative serum levels of lactate dehydrogenase (LDH) predicted outcome 3 months after surgery in patients with aneurysmal subarachnoid hemorrhage (aSAH) treated using microsurgical clipping in our institution. Methods: Patients with aSAH treated at our institution between 2010 and 2018 were enrolled. The following parameters were recorded: age, sex, smoking and drinking history, medical history, Hunt–Hess and Fisher grades, aneurysm location, aneurysm size, surgical treatment, delayed cerebral ischemia (DCI), intracranial infection, hydrocephalus, pneumonia, and preoperative serum LDH levels within 24 h of aSAH. We investigated whether preoperative serum LDH levels were associated with Hunt–Hess grade, Fisher grade, and functional neurological outcome. Results: In total, 2,054 patients with aSAH were enrolled, 874 of whom were treated using microsurgical clipping. The average serum LDH level (U/L) was significantly lower in the good outcome group (180.096 ± 50.237) than in the poor outcome group (227.554 ± 83.002; p < 0.001). After propensity score matching, the average serum LDH level (U/L) was still lower in the good outcome group (205.356 ± 76.785) than in the poor outcome group (227.119 ± 86.469; p = 0.029). The area under the receiver operating characteristic (ROC) curve was 0.702 (95% confidence interval [CI]: 0.650–0.754; p < 0.001). Based on the ROC curve, the optimal cutoff value for serum LDH levels as a predictor of poor 3-month outcome (modified Rankin Scale score > 2) was 201.5 U/L. The results revealed that Hunt–Hess grade, Fisher grade, DCI, pneumonia, and serum LDH (>201.5 U/L) were significantly associated with poor outcome. After propensity score matching, serum LDH levels > 201.5 U/L were still considered an independent risk factor for poor outcome (odds ratio: 2.426, 95% CI = 1.378–4.271, p = 0.002). Serum LDH levels were associated with Hunt–Hess and Fisher grades and were correlated with functional neurological outcomes (p < 0.001). Conclusions: Our findings showed that higher preoperative serum levels of LDH correlated with Hunt–Hess grade, Fisher grade, and neurological functional outcome, and predicted the outcome of aSAH treated by microsurgical clipping at 3 months, which was involved in the related mechanisms of early brain injury and showed its potential clinical significance in patients with aSAH.
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Affiliation(s)
- Shufa Zheng
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Haojie Wang
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Guorong Chen
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Huangcheng Shangguan
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Lianghong Yu
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Zhangya Lin
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yuanxiang Lin
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Peisen Yao
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Dezhi Kang
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.,Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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12
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You YH, In YN, Park JS, Yoo I, Kim SW, Lee J, Ryu S, Min JH, Jeong WJ, Cho YC, Oh SK, Ahn HJ, Kang CS, Lee BK, Lee DH, Lee DH, Yu GG. Relationships between serum levels of lactate dehydrogenase and neurological outcomes of patients who underwent targeted temperature management after out-of-hospital cardiac arrest. Medicine (Baltimore) 2021; 100:e26260. [PMID: 34128855 PMCID: PMC8213304 DOI: 10.1097/md.0000000000026260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/20/2021] [Indexed: 01/04/2023] Open
Abstract
This study aimed to evaluate times for measuring serum lactate dehydrogenase levels (SLLs) to predict neurological prognosis among out-of-hospital cardiac arrest (OHCA) survivors.This retrospective study examined patients who experienced OHCA treated with targeted temperature management (TTM). The SLLs were evaluated at the return of spontaneous circulation (ROSC) and at 24, 48, and 72 hours later. Neurological outcomes after 3 months were evaluated for relationships with the SLL measurement times.A total of 95 comatose patients with OHCA were treated using TTM. Seventy three patients were considered eligible, including 31 patients (42%) who experienced good neurological outcomes. There were significant differences between the good and poor outcome groups at most time points (P < .001), except for ROSC (P = .06). The ROSC measurement had a lower area under the receiver operating characteristic curve (AUC: 0.631, 95% confidence interval [CI]: 0.502-0.761) than at 48 hours (AUC: 0.830, 95% CI: 0.736-0.924), at 24 hours (AUC: 0.786, 95% CI: 0.681-0.892), and at 72 hours (AUC: 0.821, 95% CI: 0.724-0.919).A higher SLL seemingly predicted poor neurological outcomes, with good prognostic values at 48 hours and 72 hours. Prospective studies should be conducted to confirm these results.
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Affiliation(s)
- Yeon Ho You
- Department of Emergency Medicine, Chungnam National University Hospital
| | - Yong Nam In
- Department of Emergency Medicine, College of Medicine, Chungnam National University, Jung-gu, Daejeon
- Department of Emergency Medicine, Chungnam National University Sejong Hospital, Sejong
| | - Jung Soo Park
- Department of Emergency Medicine, Chungnam National University Hospital
- Department of Emergency Medicine, College of Medicine, Chungnam National University, Jung-gu, Daejeon
| | - Insool Yoo
- Department of Emergency Medicine, Chungnam National University Hospital
- Department of Emergency Medicine, College of Medicine, Chungnam National University, Jung-gu, Daejeon
| | - Seung Whan Kim
- Department of Emergency Medicine, Chungnam National University Hospital
- Department of Emergency Medicine, College of Medicine, Chungnam National University, Jung-gu, Daejeon
| | - Jinwoong Lee
- Department of Emergency Medicine, Chungnam National University Hospital
| | - Seung Ryu
- Department of Emergency Medicine, Chungnam National University Hospital
| | - Jin Hong Min
- Department of Emergency Medicine, College of Medicine, Chungnam National University, Jung-gu, Daejeon
- Department of Emergency Medicine, Chungnam National University Sejong Hospital, Sejong
| | - Won Joon Jeong
- Department of Emergency Medicine, Chungnam National University Hospital
| | - Yong Chul Cho
- Department of Emergency Medicine, Chungnam National University Hospital
| | - Se Kwang Oh
- Department of Emergency Medicine, College of Medicine, Chungnam National University, Jung-gu, Daejeon
- Department of Emergency Medicine, Chungnam National University Sejong Hospital, Sejong
| | - Hong Joon Ahn
- Department of Emergency Medicine, Chungnam National University Hospital
- Department of Emergency Medicine, College of Medicine, Chungnam National University, Jung-gu, Daejeon
| | - Chang Shin Kang
- Department of Emergency Medicine, Chungnam National University Hospital
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University School of Medicine
- Department of Emergency Medicine, Chonnam National University Hospital, Dong-gu, Gwangju
| | - Dong Hun Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Dong-gu, Gwangju
| | - Dong Hoon Lee
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Dongjak-gu, Seoul
| | - Gyeong Gyu Yu
- Department of Emergency Medical Service, Seojeong University, Eunhyeon-myeon, Yangju-si, Gyeonggi-do, Republic of Korea
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Bae IS, Chun HJ, Yi HJ, Bak KH, Choi KS, Kim DW. Modified Glasgow Coma Scale Using Serum Factors as a Prognostic Model in Traumatic Brain Injury. World Neurosurg 2019; 126:e959-e964. [PMID: 30876987 DOI: 10.1016/j.wneu.2019.02.197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- In-Suk Bae
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, South Korea
| | - Hyoung-Joon Chun
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, South Korea.
| | - Hyeong-Joong Yi
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, South Korea
| | - Koang-Hum Bak
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, South Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, South Korea
| | - Dong-Won Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, Seoul, South Korea
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Hayakawa M, Maekawa K, Kushimoto S, Kato H, Sasaki J, Ogura H, Matsuoka T, Uejima T, Morimura N, Ishikura H, Hagiwara A, Takeda M, Kaneko N, Saitoh D, Kudo D, Kanemura T, Shibusawa T, Furugori S, Nakamura Y, Shiraishi A, Murata K, Mayama G, Yaguchi A, Kim S, Takasu O, Nishiyama K. Hyperfibrinolysis in severe isolated traumatic brain injury may occur without tissue hypoperfusion: a retrospective observational multicentre study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:222. [PMID: 28830477 PMCID: PMC5568058 DOI: 10.1186/s13054-017-1811-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 08/07/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Hyperfibrinolysis is a critical complication in severe trauma. Hyperfibrinolysis is traditionally diagnosed via elevated D-dimer or fibrin/fibrinogen degradation product levels, and recently, using thromboelastometry. Although hyperfibrinolysis is observed in patients with severe isolated traumatic brain injury (TBI) on arrival at the emergency department (ED), it is unclear which factors induce hyperfibrinolysis. The present study aimed to investigate the factors associated with hyperfibrinolysis in patients with isolated severe TBI. METHODS We conducted a multicentre retrospective review of data for adult trauma patients with an injury severity score ≥ 16, and selected patients with isolated TBI (TBI group) and extra-cranial trauma (non-TBI group). The TBI group included patients with an abbreviated injury score (AIS) for the head ≥ 4 and an extra-cranial AIS < 2. The non-TBI group included patients with an extra-cranial AIS ≥ 3 and head AIS < 2. Hyperfibrinolysis was defined as a D-dimer level ≥ 38 mg/L on arrival at the ED. We evaluated the relationships between hyperfibrinolysis and injury severity/tissue injury/tissue perfusion in TBI patients by comparing them with non-TBI patients. RESULTS We enrolled 111 patients in the TBI group and 126 in the non-TBI group. In both groups, patients with hyperfibrinolysis had more severe injuries and received transfusion more frequently than patients without hyperfibrinolysis. Tissue injury, evaluated on the basis of lactate dehydrogenase and creatine kinase levels, was associated with hyperfibrinolysis in both groups. Among patients with TBI, the mortality rate was higher in those with hyperfibrinolysis than in those without hyperfibrinolysis. Tissue hypoperfusion, evaluated on the basis of lactate level, was associated with hyperfibrinolysis in only the non-TBI group. Although the increase in lactate level was correlated with the deterioration of coagulofibrinolytic variables (prolonged prothrombin time and activated partial thromboplastin time, decreased fibrinogen levels, and increased D-dimer levels) in the non-TBI group, no such correlation was observed in the TBI group. CONCLUSIONS Hyperfibrinolysis is associated with tissue injury and trauma severity in TBI and non-TBI patients. However, tissue hypoperfusion is associated with hyperfibrinolysis in non-TBI patients, but not in TBI patients. Tissue hypoperfusion may not be a prerequisite for the occurrence of hyperfibrinolysis in patients with isolated TBI.
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Affiliation(s)
- Mineji Hayakawa
- Emergency and Critical Care Center, Hokkaido University Hospital, N14W5, Kita-ku, Sapporo, 060-8648, Japan.
| | - Kunihiko Maekawa
- Emergency and Critical Care Center, Hokkaido University Hospital, N14W5, Kita-ku, Sapporo, 060-8648, Japan
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Kato
- Department of Critical Care and Traumatology, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Junichi Sasaki
- Department of Emergency & Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tetsuya Matsuoka
- Senshu Trauma and Critical Care Center, Rinku General Medical Center, Osaka, Japan
| | - Toshifumi Uejima
- Department of Emergency and Critical Care Medicine, Kinki University Faculty of Medicine, Osaka, Japan
| | - Naoto Morimura
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroyasu Ishikura
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Akiyoshi Hagiwara
- Department of Emergency Medicine and Critical Care, National Center for Global Health and Medicine, Tokyo, Japan
| | - Munekazu Takeda
- Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Naoyuki Kaneko
- Trauma and Emergency Center, Fukaya Red Cross Hospital, Saitama, Japan
| | - Daizoh Saitoh
- Division of Traumatology, Research Institute, National Defence Medical College, Saitama, Japan
| | - Daisuke Kudo
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Kanemura
- Department of Critical Care and Traumatology, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Takayuki Shibusawa
- Department of Emergency & Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shintaro Furugori
- Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yoshihiko Nakamura
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Atsushi Shiraishi
- Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Kiyoshi Murata
- Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Gou Mayama
- Department of Emergency Medicine and Critical Care, National Center for Global Health and Medicine, Tokyo, Japan
| | - Arino Yaguchi
- Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Shiei Kim
- Department of Emergency & Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Osamu Takasu
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Kazutaka Nishiyama
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
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Sabetghadam A, Ramanathan S, Sasidharan S, Mansor SM. Subchronic exposure to mitragynine, the principal alkaloid of Mitragyna speciosa, in rats. JOURNAL OF ETHNOPHARMACOLOGY 2013; 146:815-823. [PMID: 23422336 DOI: 10.1016/j.jep.2013.02.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 02/06/2013] [Accepted: 02/08/2013] [Indexed: 06/01/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Mitragyna speciosa is a popular medicinal plant in Southeast Asia which is commonly used for its morphine-like effects. Although the analgesic properties of Mitragyna speciosa and its ability to ameliorate withdrawal signs after abrupt cessation of opioid abuse are well known, information about the long-term safety of the plant's active compounds is lacking. In this work, we evaluated the effects of sub-chronic exposure to mitragynine, the principal alkaloid of Mitragyna speciosa leaves in rats. MATERIALS AND METHODS Male and female Sprague-Dawley rats received three doses of mitragynine (1, 10, 100mg/kg, p.o) for 28 days respectively. Food intake and relative body weight were measured during the experiment. After completion of drug treatment biochemical, hematological, and histological analyses were performed. RESULTS No mortality was observed in any of the treatment groups. The groups of rats treated with the lower and intermediate doses showed no toxic effects during the study. However, the relative body weight of the group of female rats treated with the 100mg/kg dose was decreased significantly. Food intake also tended to decrease in the same group. Only relative liver weight increased after treatment with the high dose of mitragynine (100mg/ kg) in both the male and female treatment groups of rats. Biochemical and hematological parameters were also altered especially in high dose treatment group which corresponds to the histopathological changes. CONCLUSIONS The study demonstrated that mitragynine is relatively safe at lower sub-chronic doses (1-10mg/kg) but exhibited toxicity at a highest dose (sub-chronic 28 days: 100mg/kg). This was confirmed by liver, kidney, and brain histopathological changes, as well as hematological and biochemical changes.
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Affiliation(s)
- Azadeh Sabetghadam
- Centre for Drug Research, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia
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Bloomfield SM, McKinney J, Smith L, Brisman J. Reliability of S100B in predicting severity of central nervous system injury. Neurocrit Care 2007; 6:121-38. [PMID: 17522796 DOI: 10.1007/s12028-007-0008-x] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
S100B is a protein biomarker that reflects CNS injury. It can be measured in the CSF or serum with readily available immunoassay kits. The excellent sensitivity of S100B has enabled it to confirm the existence of subtle brain injury in patients with mild head trauma, strokes, and after successful resuscitation from cardiopulmonary arrest. The extent of S100B elevation has been found to be useful in predicting clinical outcome after brain injury. Elevations of S100B above certain threshold levels might be able to reliably predict brain death or mortality. A normal S100B level reliably predicts the absence of significant CNS injury. The specificity of S100B levels as a reflection of CNS injury is compromised by the findings that extra-cranial injuries can lead to elevations in the absence of brain injury. This potential problem can most likely be avoided by measuring serial S100B levels along with other biomarkers and carefully noting peripheral injuries. Serum markers GFAP and NSE are both more specific for CNS injury and have little to no extra-cranial sources. Sustained elevations of S100B over 24 h along with elevations of GFAP and NSE can more reliably predict the extent of brain injury and clinical outcomes. In the future, S100B measurements might reliably predict secondary brain injury and enable physicians to initiate therapeutic interventions in a timelier manner. S100B levels have been shown to rise hours to days before changes in ICP, neurological examinations, and neuroimaging tests. S100B levels may also be used to monitor the efficacy of treatments.
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Affiliation(s)
- Stephen M Bloomfield
- New Jersey Neuroscience, Institute JFK Hospital and Medical Center, Edison, NJ 08818, USA.
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17
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Abstract
The knowledge of the so called prognostic factors or indicators involved in severe head injury (SHI) is an issue of great interest to make predictions about the future of patients with this pathology. Those indicators constitute the basic elements of the different prognostic formulas or models carried out in order to make predictions in SHI. The mentioned models, therefore, will be constructed by a group of variables (prognostic indicators or factors) and several scales (prognostic scales) that are useful for measuring the final outcome of these patients. In this paper we resume, after an exhaustive review of the literature, the knowledge about the prognostic factors related to SHI. These indicators have been classified as follows: clinical, radiological, physiological, and biochemical. Moreover, we have briefly described the prognostic scales more commonly used in SHI.
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Affiliation(s)
- G R Boto
- Servicio de Neurocirugía y Unidad de Epidemiología Clínica, Hospital 12 de Octubre. Madrid
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18
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Pelinka LE, Toegel E, Mauritz W, Redl H. Serum S 100 B: a marker of brain damage in traumatic brain injury with and without multiple trauma. Shock 2003; 19:195-200. [PMID: 12630517 DOI: 10.1097/00024382-200303000-00001] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This prospective clinical study was conducted to determine whether S 100 B is a reliable serum marker for traumatic brain injury (TBI) with and without multiple trauma. Fifty-five trauma patients (Injury Severity Score [ISS] > or = 24 and Glasgow Coma Score [GCS] < or = 8) were classified by radiography, computer tomography, ultrasound, and neurology as TBI without multiple trauma (n = 23), TBI with multiple trauma (n = 23), or multiple trauma without TBI (n = 9). S 100 B was measured initially after trauma and daily for a maximum of 21 days. Both survivors and nonsurvivors had markedly increased S 100 B initially. All survivors returned to normal or moderately increased S 100 B levels within the first 48 h after trauma. In contrast, all nonsurvivors of isolated TBI had S 100 B values that either increased consistently or dropped and then increased again 48 h after the initial increase after trauma. There was no relationship between localization, extent, or severity of TBI and S 100 B. According to receiver operating characteristic curve analysis and calculation of the area under the curve (AUC), S 100 B is equally accurate for mortality prediction at 24, 48, and 72 h after trauma and is most accurate >84 h after trauma. Sensitivity/specificity for mortality prediction are more accurate in TBI without multiple trauma (AUC 0.802-0.971) than in TBI with multiple trauma (AUC 0.693-0.783). Thus, though S 100 B may be a reliable marker of brain damage in TBI without multiple trauma 24 h after trauma and thereafter, it appears to be less reliable in TBI with multiple trauma.
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Affiliation(s)
- Linda E Pelinka
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Research Center for Traumatology of the Austrian Workers' Compensation Board, Vienna, Austria
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Ingebrigtsen T, Romner B. Biochemical serum markers of traumatic brain injury. THE JOURNAL OF TRAUMA 2002; 52:798-808. [PMID: 11956409 DOI: 10.1097/00005373-200204000-00038] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Tor Ingebrigtsen
- Department of Neurosurgery, Tromsø University Hospital, Tromsø, Norway.
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Abstract
OBJECTIVE Despite the significant recent progress in cerebral monitoring, it is still difficult to quantify the extent of primary brain injury and ongoing secondary damage after head injury. The objective of our study was to investigate S-100B protein as a serum marker of brain damage after severe head injury. METHODS Eighty-four patients with severe head injury (Glasgow Coma Scale score < or =8) were included in this prospective study. Venous blood samples for S-100B protein were obtained as soon as possible after admission and every 24 hours thereafter, for a maximum of 10 consecutive days. Serum levels of S-100B protein were compared with outcome after 6 months, clinical variables, and the category of the Marshall classification of initial computed tomographic findings. RESULTS Patients who died had significantly higher serum S-100B values compared with those who survived (median, 2.7 microg/L versus 0.54 microg/L; P < 0.0001, Mann-Whitney U test). Nineteen (58%) of 33 patients who died had peak S-100B values of 2 microg/L or higher, compared with 4 (8%) of the 51 surviving patients (P < 0.0005, Fisher's exact test). There was also a strong correlation between S-100B values and computed tomographic findings. Logistic regression analysis in a model with age, Glasgow Coma Scale score, intracranial pressure, and computed tomographic findings revealed S-100B as an independent predictor of outcome. Persistent elevation of S-100B levels for 2 to 6 days, even in patients with favorable outcome, may reflect ongoing secondary damage after severe head injury. CONCLUSION S-100B may be a promising serum marker for assessing the extent of primary injury and the time course of secondary damage after severe head injury.
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Affiliation(s)
- A Raabe
- Department of Neurosurgery, University of Leipzig, Germany
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21
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Quantification of midline shift as a predictor of poor outcome following head injury. SURGICAL NEUROLOGY 1991; 35:183-8. [PMID: 1996446 DOI: 10.1016/0090-3019(91)90069-l] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A retrospective study of patient outcome, based on admission computed tomography, was carried out in 75 consecutive patients with head injury. Computed tomography data collected included the type and extent of intracranial hemorrhage, the extent of midline shift, and the ratio of midline shift compared with the extent of intracranial hemorrhage. Midline shift was considered to be out of proportion to intracranial hemorrhage when the midline shift of the septum pellucidum exceeded the extent of the hemorrhage as measured radially from the inner table of the skull. When computed tomography data were analyzed by logistic regression, significant predictive factors for poor outcome were intracranial hemorrhage (34%), intracranial hemorrhage with midline shift (61%), and midline shift out of proportion to the extent of intracranial hemorrhage (88%). When patient outcome and mortality rates are considered, our study indicates that midline shift out of proportion to the extent of intracranial hemorrhage is a highly useful predictor of poor patient outcome following head injury.
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Paşaoğlu A, Paşaoğlu H. Enzymatic changes in the cerebrospinal fluid as indices of pathological change. Acta Neurochir (Wien) 1989; 97:71-6. [PMID: 2718797 DOI: 10.1007/bf01577743] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Enzymatic determinations in cerebrospinal fluid (CSF) of lactic dehydrogenase (LDH), creatine phosphokinase (CPK) and creatine kinase BB (CK-BB) were performed on 94 patients presenting with a range of disorders of the central nervous system. Enzyme results from 37 patients undergoing myelography were used as controls. The highest concentration of these enzymes appeared in patients with the most severe brain injury. In head-injured patients with a Glasgow Coma Score (GCS) of 3 to 7, only the CK-BB correlated with the degree of injury and with the ultimate outcome. Within the subgroup of spinal cord injuries none of the enzymes correlated with the severity of neurological injury. However, patients with acute spinal cord trauma who demonstrated CSF CK-BB values greater than 10 U/litre had never recovered. The present study confirms that CSF CK-BB seems to be a sensitive index of acute brain damage, but it reflects best the extent of CNS tissue disruption rather than the severity of neurological deficits.
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Affiliation(s)
- A Paşaoğlu
- Department of Neurosurgery, Erciyes University Medical School, Kayseri, Turkey
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Curley P, Abbott R, Vallance D. Clinical application of a new enzyme-linked assay for the estimation of brain-specific creatine kinase in head injured patients. Br J Neurosurg 1989; 3:655-8. [PMID: 2627284 DOI: 10.3109/02688698908992688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The clinical value of serum brain specific creatine kinase (CK-BB) was assessed in head injured patients (group A) using a new enzyme-linked immunosorbent assay (ELISA). The results were compared to healthy controls (group B) and patients post-myocardial infarction (group C). None of the head injured patients had undergone a surgical procedure or ventricular puncture. CK-BB was significantly higher in group A than in controls. The level of CK-BB in group A was inversely proportional to the Glasgow Coma Scale on admission. All patients with a CK-BB greater than 100 micrograms/l died. The ELISA technique is a simple and reliable assay with prognostic significance in patients with head injury and has wider clinical application than the previously described radioimmunoassay methods.
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Affiliation(s)
- P Curley
- Department of Surgery, Leicester Royal Infirmary
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Anagnostopoulos DI, Dontas IA, Kotsarelis DV, Julien G, Karayannacos PE, Diakolios CE, Skalkeas GD. Creatine kinase (CK-BB) determination in cerebrospinal fluid after acute experimental head injury. Br J Neurosurg 1988; 2:169-72. [PMID: 3267300 DOI: 10.3109/02688698808992666] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Early changes of the activity of enzymes such as creatine kinase in the cerebrospinal fluid (CSF) or serum are often investigated after head injuries to assess the extent of brain damage and establish a reliable prognosis. The purpose of the present study was to determine levels of creatine kinase isoenzyme CK-BB in the CSF of rats after experimental head injuries. External head injuries of different severity were inflicted on rats, immediately after which CSF was collected for isoenzyme activity determination. It was found that the levels of CK-BB were significantly elevated immediately after the head injury and that the greater the degree of external cranial injury inflicted, the higher the isoenzyme activity was. The results seem to provide evidence that CK-BB activity is an early indicator of brain damage and that its level may reflect the extent of cerebral damage involved.
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Affiliation(s)
- D I Anagnostopoulos
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Greece
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Politis MJ, Pellegrino RG, Ritchie JM. The role of post-traumatic mitosis in elevation of anaerobic metabolism enzyme (lactic acid dehydrogenase) activity in degenerating central and peripheral nerve. Brain Res 1985; 359:187-93. [PMID: 4075142 DOI: 10.1016/0006-8993(85)91428-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Glial and Schwann cells undergo marked biochemical and morphological alterations following axonal injury. In the present experiments, the extent of enzyme activity associated with anaerobic (LDH, lactic dehydrogenase) vs aerobic (SDH, succinic dehydrogenase) respiration was assessed distal to the site of nerve fiber injury. Studies were performed in rat central (optic) and peripheral (sciatic) nerves at 2, 7 and 14 days postoperatively (d.p.o.). In sciatic nerves, LDH activity rose 3-fold in traumatized (vs unoperated control) nerve tissue between 2 and 7 d.p.o. and remained elevated at 14 d.p.o. SDH activity in traumatized nerve was equal to that in unoperated nerve at 7 d.p.o., but decreased at 14 d.p.o. LDH activity in optic nerve at 2 d.p.o. was equivalent to that in control nerve, but rose approximately two-fold by 7 d.p.o. However, unlike peripheral nerve, activity in traumatized optic nerve decreased to control levels at 14 d.p.o. SDH activity in traumatized optic nerve remained unchanged at any timepoint examined. Taken in concert, these data are consistent with the hypothesis that there is an overall shift in CNS glial and Schwann cell metabolism from aerobic to anaerobic respiration following nerve injury. Additional studies were performed to determine if this shift requires prior Schwann or glial cell mitosis. Administration of mitotic inhibitor (AraC, cytosine arabinofuranoside) inhibited post-traumatic elevations in LDH activity in optic, but not peripheral nerve. No significant effect of the drug on axonal degeneration (as assessed by saxitoxin binding) was observed.
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Rabow L, Hedman G. Creatine kinaseBB-activity after head trauma related to outcome. Acta Neurochir (Wien) 1985; 76:137-9. [PMID: 4025020 DOI: 10.1007/bf01418476] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The brain-type isoenzyme of creatine kinase was determined in serum (S) and cerebrospinal fluid (CSF) in 37 patients with severe head injury, and a correlation was made with the Glasgow coma score and Glasgow outcome score. All patients with normal S-CKBB and CSF-CKBB activities had a coma score of 15, i.e., no neurological deficits, at six hours after the trauma and a good outcome. All 15 patients with a significant increase in the enzyme in serum and CSF had a coma score less than 15. The outcome was still good for five of these patients, while six were moderately disabled, two were severely disabled, and two died. There was no correlation between the individual CKBB-values and the outcome.
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Abstract
✓ Enzymatic determinations in serum and cerebrospinal fluid (CSF) of creatine phosphokinase (CPK) and its isoenzymes, lactic dehydrogenase (LDH) and its isoenzymes, and glutamic oxaloacetic transaminase (GOT) were performed on patients with closed head injury with Glasgow Coma Scale (GCS) scores of 3 to 15. The purpose of the work was to study the usefulness of these determinations as a biochemical index of brain injury. Detailed analysis of serum determinations on 139 patients demonstrated a prognostic correlation for only the CPK1 isoenzyme. The presence of the CPK1 isoenzyme correlated with the degree of head injury (as indexed by the GCS) and with the ultimate outcome. Although the presence of the CPK1 isoenzyme was a foreboding sign, it was not consistently present even with severe head injury, and its presence was not invariably associated with poor outcome. Therefore, serum enzymatic determinations have an inadequate sensitivity and specificity for use as an index of neurological trauma.
Fifty-seven patients had CSF enzymatic determinations, and each of the enzymes studied was correlated directly with GCS and with the ultimate outcome. Within the subgroup of severely head-injured patients with a GCS score of 3 to 7, only the CPK1 and LDH1 isoenzymes correlated with the degree of head trauma and outcome. The CPK1 isoenzymes were not detectable in CSF from control patients, but were invariably present following head trauma. These CPK1 isoenzymes in the CSF were particularly useful in that they appeared in the acute course and were subsequently absent unless secondary injury to the brain occurred causing additional neurological damage. Secondary injuries due to delayed hemorrhage, infarction, hypoxia, or pathological evaluations of intracranial pressure were readily detected. The LDH1 isoenzyme is present in the CSF from normal patients and does elevate with neurological trauma; these LDH1 isoenzymes appear to be elevated for a period of weeks to months following injury and thus are less useful in detecting secondary injuries. An attempt was made to investigate the effect of Decadron (dexamethasone) on these enzymatic changes, but no significant effect was identified. Also noted in this study was the presence of CPK1 isoenzymes in the CSF of patients with gunshot wounds to the head, spinal cord injuries, and herniation syndromes. It is concluded, therefore, that CPK1 isoenzymes in the CSF appear to be a specific marker for neurological trauma, and may be of value both in clinical practice and in clinical investigations.
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Phillips JP, Jones HM, Hitchcock R, Adama N, Thompson RJ. Radioimmunoassay of serum creatine kinase BB as index of brain damage after head injury. BRITISH MEDICAL JOURNAL 1980; 281:777-9. [PMID: 7427445 PMCID: PMC1714045 DOI: 10.1136/bmj.281.6243.777] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Brain-type creatine kinase isoenzymes (CK-BB) was measured by radioimmunoassay in the serum of 54 patients with head injuries. CK-BB was not detectable in 476 out of 1006 controls, the remaining 530 normal samples containing a mean of 1.5 +/- SD0.75 microgram/l. The mean CK-BB concentrations in patients with mild, moderate, and fatal head injuries were all significantly higher than the control value (p < 0.01 in each instance). Patients with serious head injury had serum concentrations many times the normal value, in two cases within 30 minutes after impact. Fatally injured patients continued to have high serum concentrations several days after injury. In less serious cases values approached normal within two or three days. Every patient with evidence of cerebral laceration, bruising, or swelling had a serum CK-BB concentration above normal. Raised concentrations were found in 14 out of 22 patients with concussion only. The serum CK-BB concentration appears to be a sensitive index of brain damage and may prove useful in the management and follow-up of head-injured patients.
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Abstract
The circulating levels of plasma catecholamines (norepinephrine and epinephrine) and serotonin (5-HT) were estimated in 65 cases of head injury. The plasma levels of these amines of patients were compared with those of normal healthy volunteers. The levels were significantly higher in severe head injuries as compared to mild injuries and have prognostic significance.
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Rabow L, Hedman G. CKBB-isoenzymes as a sign of cerebral injury. ACTA NEUROCHIRURGICA. SUPPLEMENTUM 1979; 28:108-12. [PMID: 290132 DOI: 10.1007/978-3-7091-4088-8_24] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
CKBB-isoenzymes in serum and CSF have been shown to be raised in patients after head injury with objective signs of damaged brain tissues (contusio cerebri), but not in the absence of these signs (commotio cerebri).
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