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Open Access 20-02-2024 | Biomarkers | Original

Early systemic insults following traumatic brain injury: association with biomarker profiles, therapy for intracranial hypertension, and neurological outcomes—an analysis of CENTER-TBI data

Authors: Chiara Robba, Francesca Graziano, Edoardo Picetti, Cecilia Åkerlund, Alberto Addis, Giuseppe Pastore, Mattia Sivero, Paola Rebora, Stefania Galimberti, Nino Stocchetti, Andrew Maas, David K. Menon, Giuseppe Citerio, the CENTER-TBI Participants and Investigators

Published in: Intensive Care Medicine | Issue 3/2024

Abstract

Purpose

We analysed the impact of early systemic insults (hypoxemia and hypotension, SIs) on brain injury biomarker profiles, acute care requirements during intensive care unit (ICU) stay, and 6-month outcomes in patients with traumatic brain injury (TBI).

Methods

From patients recruited to the Collaborative European neurotrauma effectiveness research in TBI (CENTER-TBI) study, we documented the prevalence and risk factors for SIs and analysed their effect on the levels of brain injury biomarkers [S100 calcium-binding protein B (S100B), neuron-specific enolase (NSE), neurofilament light (NfL), glial fibrillary acidic protein (GFAP), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and protein Tau], critical care needs, and 6-month outcomes [Glasgow Outcome Scale Extended (GOSE)].

Results

Among 1695 TBI patients, 24.5% had SIs: 16.1% had hypoxemia, 15.2% had hypotension, and 6.8% had both. Biomarkers differed by SI category, with higher S100B, Tau, UCH-L1, NSE and NfL values in patients with hypotension or both SIs. The ratio of neural to glial injury (quantified as UCH-L1/GFAP and Tau/GFAP ratios) was higher in patients with hypotension than in those with no SIs or hypoxia alone. At 6 months, 380 patients died (22%), and 759 (45%) had GOSE ≤ 4. Patients who experienced at least one SI had higher mortality than those who did not (31.8% vs. 19%, p < 0.001).

Conclusion

Though less frequent than previously described, SIs in TBI patients are associated with higher release of neuronal than glial injury biomarkers and with increased requirements for ICU therapies aimed at reducing intracranial hypertension. Hypotension or combined SIs are significantly associated with adverse 6-month outcomes. Current criteria for hypotension may lead to higher biomarker levels and more negative outcomes than those for hypoxemia suggesting a need to revisit pressure targets in the prehospital settings.

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Title: Early systemic insults following traumatic brain injury: association with biomarker profiles, therapy for intracranial hypertension, and neurological outcomes—an analysis of CENTER-TBI data
Authors: Chiara Robba
Francesca Graziano
Edoardo Picetti
Cecilia Åkerlund
Alberto Addis
Giuseppe Pastore
Mattia Sivero
Paola Rebora
Stefania Galimberti
Nino Stocchetti
Andrew Maas
David K. Menon
Giuseppe Citerio
the CENTER-TBI Participants and Investigators
Publication date: 20-02-2024
Publisher: Springer Berlin Heidelberg
Keywords: Biomarkers
Central Nervous System Trauma
Hypotension
Hypotension
Hypoxemia
Intracranial Hypertension
Published in: Intensive Care Medicine / Issue 3/2024
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-024-07324-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Early systemic insults following traumatic brain injury: association with biomarker profiles, therapy for intracranial hypertension, and neurological outcomes—an analysis of CENTER-TBI data

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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