Leonardo Lorente1, María M Martín2, Agustín F González-Rivero3, Luis Ramos4, Mónica Argueso5, Juan J Cáceres6, Jordi Solé-Violán7, Nicolás Serrano8, Sergio T Rodríguez2, Alejandro Jiménez9, Juan M Borreguero-León3. 1. Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n. La Laguna - 38320, Santa Cruz de Tenerife, Spain. Electronic address: lorentemartin@msn.com. 2. Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Crta del Rosario s/n. Santa Cruz de Tenerife - 38010, Spain. 3. Laboratory Deparment, Hospital Universitario de Canarias, Ofra, s/n. La Laguna - 38320, Santa Cruz de Tenerife, Spain. 4. Intensive Care Unit, Hospital General La Palma, Buenavista de Arriba s/n, Breña Alta, La Palma- 38713, Spain. 5. Intensive Care Unit, Hospital Clínico Universitario de Valencia, Avda, Blasco Ibáñez n°17-19, Valencia - 46004, Spain. 6. Intensive Care Unit, Hospital Insular, Plaza Dr. Pasteur s/n. Las Palmas de Gran Canaria - 35016, Spain. 7. Intensive Care Unit, Hospital Universitario Dr. Negrín, Barranco de la Ballena s/n. Las Palmas de Gran Canaria - 35010, Spain. 8. Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n. La Laguna - 38320, Santa Cruz de Tenerife, Spain. 9. Research Unit, Hospital Universitario de Canarias, Ofra, s/n. La Laguna - 38320, Santa Cruz de Tenerife, Spain.
Abstract
BACKGROUND: Serum soluble CD40 Ligand (sCD40L) levels, which exhibit prothrombotic and proinflammatory properties, have not been studied in patients with traumatic brain injury (TBI). Thus, the objective of this study was to determine whether serum sCD40L levels are associated with severity and mortality in patients with severe TBI. METHODS: This was a prospective, observational and multicenter study carried out in six Spanish Intensive Care Units. Patients with severe TBI defined as Glasgow Coma Scale (GCS) lower than 9 were included, while those with Injury Severity Score (ISS) in non-cranial aspects higher than 9 were excluded. Serum levels of sCD40L were measured on the day of TBI. Endpoint was established in 30-day mortality. RESULTS: We found higher serum sCD40L levels (P<0.001) in non-surviving TBI patients (N=27) than in survivor ones (N=73). Logistic regression analysis showed that serum sCD40L levels were associated with 30-day mortality (OR=1.58; 95% CI=1.12-2.21; P=0.008) controlling for APACHE-II score and computer tomography findings. The area under the curve (AUC) for serum sCD40L levels as predictor of 30-day mortality was 0.79 (95% CI=0.70-0.86; P<0.001). Survival analysis showed that patients with serum sCD40L levels higher than 2.11 ng/mL presented increased 30-day mortality than patients with lower levels (Hazard ratio=9.0; 95% CI=4.25-19.27; P<0.001). We found an association between serum sCD40L levels and APACHE-II (rho=0.33; P=0.001), and GCS score (rho=-0.21; P=0.04). CONCLUSIONS: To our knowledge, this is the first study reporting data on serum sCD40L levels in patients with severe TBI. The most relevant and newer findings of our study are that serum sCD40L levels in non-surviving patients with severe TBI are higher than in surviving ones, and that there are an association between serum sCD40L levels and TBI severity and mortality.
BACKGROUND: Serum soluble CD40 Ligand (sCD40L) levels, which exhibit prothrombotic and proinflammatory properties, have not been studied in patients with traumatic brain injury (TBI). Thus, the objective of this study was to determine whether serum sCD40L levels are associated with severity and mortality in patients with severe TBI. METHODS: This was a prospective, observational and multicenter study carried out in six Spanish Intensive Care Units. Patients with severe TBI defined as Glasgow Coma Scale (GCS) lower than 9 were included, while those with Injury Severity Score (ISS) in non-cranial aspects higher than 9 were excluded. Serum levels of sCD40L were measured on the day of TBI. Endpoint was established in 30-day mortality. RESULTS: We found higher serum sCD40L levels (P<0.001) in non-surviving TBI patients (N=27) than in survivor ones (N=73). Logistic regression analysis showed that serum sCD40L levels were associated with 30-day mortality (OR=1.58; 95% CI=1.12-2.21; P=0.008) controlling for APACHE-II score and computer tomography findings. The area under the curve (AUC) for serum sCD40L levels as predictor of 30-day mortality was 0.79 (95% CI=0.70-0.86; P<0.001). Survival analysis showed that patients with serum sCD40L levels higher than 2.11 ng/mL presented increased 30-day mortality than patients with lower levels (Hazard ratio=9.0; 95% CI=4.25-19.27; P<0.001). We found an association between serum sCD40L levels and APACHE-II (rho=0.33; P=0.001), and GCS score (rho=-0.21; P=0.04). CONCLUSIONS: To our knowledge, this is the first study reporting data on serum sCD40L levels in patients with severe TBI. The most relevant and newer findings of our study are that serum sCD40L levels in non-surviving patients with severe TBI are higher than in surviving ones, and that there are an association between serum sCD40L levels and TBI severity and mortality.
Authors: Colin Casault; Abdulaziz S Al Sultan; Mohammad Banoei; Philippe Couillard; Andreas Kramer; Brent W Winston Journal: Neurocrit Care Date: 2019-02 Impact factor: 3.210
Authors: Fabio A Vigil; Eda Bozdemir; Vladislav Bugay; Sang H Chun; MaryAnn Hobbs; Isamar Sanchez; Shayne D Hastings; Rafael J Veraza; Deborah M Holstein; Shane M Sprague; Chase M Carver; Jose E Cavazos; Robert Brenner; James D Lechleiter; Mark S Shapiro Journal: J Cereb Blood Flow Metab Date: 2019-07-04 Impact factor: 6.200
Authors: Leonardo Lorente; María M Martín; Agustín F González-Rivero; Luis Ramos; Mónica Argueso; Juan J Cáceres; Jordi Solé-Violán; Alejandro Jiménez; Juan M Borreguero-León Journal: Int J Mol Sci Date: 2015-05-28 Impact factor: 5.923
Authors: Rita de Cássia Almeida Vieira; Wellingson Silva Paiva; Daniel Vieira de Oliveira; Manoel Jacobsen Teixeira; Almir Ferreira de Andrade; Regina Márcia Cardoso de Sousa Journal: Front Neurol Date: 2016-10-20 Impact factor: 4.003