Serum soluble CD40 Ligand levels are associated with severity and mortality of brain trauma injury patients
Serum soluble CD40 Ligand levels are associated with severity and mortality of brain trauma injury patients
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DOI：
10.1016/j.thromres.2014.07.034
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发表时间：
2014-10-01
影响因子：
7.5
通讯作者：
Borreguero-Leon, Juan M.
中科院分区：
文献类型：
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作者：
Lorente, Leonardo;Martin, Maria M.;Borreguero-Leon, Juan M.
背景：血清可溶性 CD40 配体 (sCD40L) 水平具有促血栓和促炎特性，尚未在创伤性脑损伤 (TBI) 患者中进行研究。因此，本研究的目的是确定血清 sCD40L 水平是否与严重 TBI 患者的严重程度和死亡率相关。方法：这是一项在六个西班牙重症监护病房进行的前瞻性、观察性和多中心研究。纳入格拉斯哥昏迷量表（GCS）低于9分的严重TBI患者，排除非颅脑损伤严重程度评分（ISS）高于9分的患者。在 TBI 当天测量 sCD40L 的血清水平。终点确定为 30 天死亡率。结果：我们发现非存活 TBI 患者 (N = 27) 的血清 sCD40L 水平 (P < 0.001) 高于幸存者 (N = 73)。 Logistic 回归分析显示，在控制 APACHE-II 评分和计算机断层扫描结果的情况下，血清 sCD40L 水平与 30 天死亡率相关（OR = 1.58；95% CI = 1.12-2.21；P = 0.008）。作为 30 天死亡率预测因子的血清 sCD40L 水平的曲线下面积 (AUC) 为 0.79 (95% CI = 0.70-0.86；P < 0.001)。生存分析显示，血清 sCD40L 水平高于 2.11 ng/mL 的患者的 30 天死亡率高于水平较低的患者（危险比 = 9.0；95% CI = 4.25-19.27；P < 0.001）。我们发现血清 sCD40L 水平与 APACHE-II (rho = 0.33; P = 0.001) 和 GCS 评分 (rho = -0.21; P = 0.04) 之间存在关联。结论：据我们所知，这是第一项报告严重 TBI 患者血清 sCD40L 水平数据的研究。我们研究中最相关和最新的发现是，未存活的严重 TBI 患者的血清 sCD40L 水平高于存活患者，并且血清 sCD40L 水平与 TBI 严重程度和死亡率之间存在关联。 (C) 2014 Elsevier Ltd. 保留所有权利。
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. (C) 2014 Elsevier Ltd. All rights reserved.