Escalating mean arterial pressure (MAP) in severe traumatic brain injury: a prospective, observational study

2020 ◽  
Author(s):  
Chien Yew Kow ◽  
Benjamin Harley ◽  
Charles LI ◽  
Phillip Romo ◽  
Panagiota GKOLIA ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mean Arterial Pressure ◽  
Observational Study ◽  
Arterial Pressure ◽  
Severe Traumatic Brain Injury ◽  
Prospective Observational Study

scholarly journals Fluid Proteomics of CSF and Serum Reveal Important Neuroinflammatory Proteins in Blood-Brain Barrier Disruption and Outcome Prediction following Severe Traumatic Brain Injury: a Prospective, Observational Study

2021 ◽  
Author(s):  
Caroline Lindblad ◽  
Elisa Pin ◽  
David Just ◽  
Faiez Al Nimer ◽  
Peter Nilsson ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Clinical Outcome ◽  
Observational Study ◽  
Blood Brain Barrier ◽  
Severe Traumatic Brain Injury ◽  
Prospective Observational Study ◽  
Brain Barrier ◽  
Severe Tbi

Abstract Background: Severe traumatic brain injury (TBI) is associated with blood-brain barrier (BBB) disruption and a subsequent neuroinflammatory process. We aimed to perform a multiplex screening of brain enriched and inflammatory proteins in blood and cerebrospinal fluid (CSF) in order to study their role in BBB disruption, neuroinflammation and long-term functional outcome in TBI patients and healthy controls. Methods: We conducted a prospective, observational study on 90 severe TBI patients and 15 control subjects. Clinical outcome data, Glasgow Outcome Score, was collected after 6-12 months. We utilized a suspension bead antibody array analyzed on a FlexMap 3D Luminex platform to characterize 177 unique proteins in matched CSF and serum samples. In addition, we assessed BBB disruption using the CSF-serum albumin quotient (QA), and performed Apolipoprotein E-genotyping as the latter has been linked to BBB function in the absence of trauma. We employed pathway-, cluster-, and proportional odds regression analyses. Key findings were validated in blood samples from an independent TBI cohort.Results: TBI patients had an upregulation of structural and neuroinflammatory pathways in both CSF and serum. In total, 114 proteins correlated with QA, among which the top-correlated proteins were complement proteins. A cluster analysis revealed protein levels to be strongly associated with BBB integrity, but not carriage of the Apolipoprotein E4-variant. Among cluster-derived proteins, innate immune pathways were upregulated. Forty unique proteins emanated as novel independent predictors of clinical outcome, that individually explained ~10% additional model variance. Among proteins significantly different between TBI patients with intact or disrupted BBB, complement C9 in CSF (p = 0.014, DR2 = 7.4%) and complement factor B in serum (p = 0.003, DR2 = 9.2%) were independent outcome predictors also following step-down modelling. Conclusions: This represents the largest concomitant CSF and serum proteomic profiling study so far reported in TBI, providing substantial support to the notion that neuroinflammatory markers, including complement activation, predicts BBB disruption and long-term outcome. Individual proteins identified here could potentially serve to refine current biomarker modelling or represent novel treatment targets in severe TBI.

scholarly journals Fluid proteomics of CSF and serum reveal important neuroinflammatory proteins in blood–brain barrier disruption and outcome prediction following severe traumatic brain injury: a prospective, observational study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Caroline Lindblad ◽  
Elisa Pin ◽  
David Just ◽  
Faiez Al Nimer ◽  
Peter Nilsson ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Clinical Outcome ◽  
Observational Study ◽  
Blood Brain Barrier ◽  
Severe Traumatic Brain Injury ◽  
Prospective Observational Study ◽  
Brain Barrier ◽  
Severe Tbi

Abstract Background Severe traumatic brain injury (TBI) is associated with blood–brain barrier (BBB) disruption and a subsequent neuroinflammatory process. We aimed to perform a multiplex screening of brain enriched and inflammatory proteins in blood and cerebrospinal fluid (CSF) in order to study their role in BBB disruption, neuroinflammation and long-term functional outcome in TBI patients and healthy controls. Methods We conducted a prospective, observational study on 90 severe TBI patients and 15 control subjects. Clinical outcome data, Glasgow Outcome Score, was collected after 6–12 months. We utilized a suspension bead antibody array analyzed on a FlexMap 3D Luminex platform to characterize 177 unique proteins in matched CSF and serum samples. In addition, we assessed BBB disruption using the CSF-serum albumin quotient (QA), and performed Apolipoprotein E-genotyping as the latter has been linked to BBB function in the absence of trauma. We employed pathway-, cluster-, and proportional odds regression analyses. Key findings were validated in blood samples from an independent TBI cohort. Results TBI patients had an upregulation of structural CNS and neuroinflammatory pathways in both CSF and serum. In total, 114 proteins correlated with QA, among which the top-correlated proteins were complement proteins. A cluster analysis revealed protein levels to be strongly associated with BBB integrity, but not carriage of the Apolipoprotein E4-variant. Among cluster-derived proteins, innate immune pathways were upregulated. Forty unique proteins emanated as novel independent predictors of clinical outcome, that individually explained ~ 10% additional model variance. Among proteins significantly different between TBI patients with intact or disrupted BBB, complement C9 in CSF (p = 0.014, ΔR2 = 7.4%) and complement factor B in serum (p = 0.003, ΔR2 = 9.2%) were independent outcome predictors also following step-down modelling. Conclusions This represents the largest concomitant CSF and serum proteomic profiling study so far reported in TBI, providing substantial support to the notion that neuroinflammatory markers, including complement activation, predicts BBB disruption and long-term outcome. Individual proteins identified here could potentially serve to refine current biomarker modelling or represent novel treatment targets in severe TBI.

scholarly journals Evaluating the predictive factors affecting outcome in patients with severe traumatic brain injury: a prospective observational study

2021 ◽  
Vol 8 (6) ◽  
pp. 1762
Author(s):  
Vikram Singh ◽  
Amar Nath ◽  
Meenu Beniwal ◽  
Paritev Singh ◽  
Rockey Dahiya
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Observational Study ◽  
Severe Traumatic Brain Injury ◽  
Prospective Observational Study ◽  
Midline Shift ◽  
Late Outcome ◽  
Severe Tbi ◽  
Ct Head ◽  
Gcs Score

Background: Severe traumatic brain injury (TBI) is a neurosurgical emergency and timely intervention is critical for favorable outcome. We aimed to evaluate certain demographic, clinical and radiological factors for outcome prediction in TBI patients in terms of morbidity and mortality.Methods: A prospective observational study was conducted in 100 patients of severe TBI admitted to our hospital from September 2016 to June 2018. Those with penetrating head injury, associated severe chest, abdominal or orthopedic trauma and pregnant or lactating women were excluded. Clinical outcome was assessed at the time of discharge and after three months according to Glasgow outcome score (GOS).Results: Majority of patients were adults in the age group 20 to 39 years. Road-side accident (75%) was the commonest mode of injury followed by fall (23%) and assault (2%). Out of 100 patients, 51 had in-hospital mortality. Of 49 patients who survived for GOS assessment at 3 months, three (6.1%) patients had unfavourable GOS I to III. Presence of hypoxemia, pupil non-reactivity, computerised tomography (CT) head findings of hemorrhagic contusion, subarachnoid hemorrhage (SAH), midline shift and effacement of basal cisterne were associated with significantly increased risk of unfavorable early and late outcome after severe TBI (p<0.05). Poor GCS score and fracture skull were associated with adverse early and late outcome respectively (p<0.001).Conclusions: Low GCS score at admission, pupil non reactivity, presence of hypoxemia, abnormal CT head findings (hemorrhagic contusion, SAH, midline shift and effacement of basal cisterne) were strong predictors of adverse outcome after severe TBI.

scholarly journals Fluid Proteomics of CSF and Serum Reveal Important Neuroinflammatory Proteins in Blood-Brain Barrier Disruption and Outcome Prediction Following Severe Traumatic Brain Injury: A Prospective, Observational Study

2020 ◽  
Author(s):  
Caroline Lindblad ◽  
Elisa Pin ◽  
David Just ◽  
Faiez Al Nimer ◽  
Peter Nilsson ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Clinical Outcome ◽  
Observational Study ◽  
Blood Brain Barrier ◽  
Severe Traumatic Brain Injury ◽  
Prospective Observational Study ◽  
Brain Barrier ◽  
Severe Tbi

Abstract Background: Severe traumatic brain injury (TBI) is associated with blood-brain barrier (BBB) disruption and a subsequent neuroinflammatory process. We aimed to perform a multiplex screening of brain enriched and inflammatory proteins in blood and cerebrospinal fluid (CSF) in order to study their role in BBB disruption, neuroinflammation and long-term functional outcome in TBI patients and healthy controls. Methods: We conducted a prospective, observational study on 90 severe TBI patients and 15 control subjects. Clinical outcome data, Glasgow Outcome Scale, was collected after 6-12 months. We utilized a suspension bead antibody array analyzed on a FlexMap 3D Luminex platform to characterize 177 unique proteins in matched CSF and serum samples. In addition, we assessed BBB disruption using the CSF-serum albumin quotient (QA), and performed Apolipoprotein E-genotyping as the latter has been linked to BBB function in the absence of trauma. We employed pathway-, cluster-, and proportional odds regression analyses.Results: TBI patients had an upregulation of structural and neuroinflammatory pathways in both CSF and serum. In total, 114 proteins correlated with QA, among which the top-correlated proteins were complement proteins. A cluster analysis revealed protein levels to be strongly associated with BBB integrity, but not carriage of the Apolipoprotein E4-variant. Among cluster-derived proteins, innate immune pathways were upregulated. Forty unique proteins emanated as novel independent predictors of clinical outcome, that individually explained ~10% additional model variance. Among proteins significantly different between TBI patients with intact or disrupted BBB, complement C9 in CSF (p = 0.014, ΔR2 = 7.4%) and complement factor B in serum (p = 0.003, ΔR2 = 9.2%) were independent outcome predictors also following step-down modelling. Conclusions: This represents the largest concomitant CSF and serum proteomic profiling study so far reported in TBI, providing substantial support to the notion that neuroinflammatory markers, including complement activation, predicts BBB disruption and long-term outcome. Individual proteins identified here could potentially serve to refine current biomarker modelling or represent novel treatment targets in severe TBI.

Semi-quantitative Cough Strength Score as a Predictor for Extubation Outcome in Traumatic Brain Injury: A Prospective Observational Study

2018 ◽  
Vol 29 (2) ◽  
pp. 273-279
Author(s):  
Abdelrady S. Ibrahim ◽  
Mohamed G. Aly ◽  
Khaled A. Abdel-Rahman ◽  
Mona A. Mohamed ◽  
Mogedda M. Mehany ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Extubation Outcome ◽  
Cough Strength
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