IMPACT probability of poor outcome and plasma cytokine concentrations are associated with multiple organ dysfunction syndrome following traumatic brain injury
IMPACT probability of poor outcome and plasma cytokine concentrations are associated with multiple organ dysfunction syndrome following traumatic brain injury
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DOI：
10.3171/2018.8.jns18676
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发表时间：
2019-12-01
影响因子：
4.1
通讯作者：
Robertson, Claudia S.
中科院分区：
文献类型：
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作者：
Lee, Sungho;Hwang, Hyunsoo;Robertson, Claudia S.
目的 创伤性脑损伤（TBI）是发病和死亡的主要原因。多器官功能障碍综合征 (MODS) 经常发生在 TBI 后，并且独立地恶化结果。本研究旨在确定与 TBI 后 MODS 相关的潜在入院特征。方法作者对最近的一项随机临床试验进行了二次分析，该试验研究促红细胞生成素和输血阈值对 TBI 后神经功能恢复的影响。使用入院临床、人口统计学、实验室和影像学参数进行多变量 Cox 回归分析，以确定 TBI 后发生 MODS 的独立危险因素，定义为 TBI 后 10 天内最大总序贯器官衰竭评估 (SOFA) 评分 > 7。 结果 最初招募了 200 名患者，最终分析中纳入了 166 名患者。呼吸功能障碍是最常见的非神经器官系统功能障碍，发生于 62% 的患者。国际临床试验预后与分析使命 (IMPACT) 入院时不良结果的概率与 TBI 后 MODS 显着相关（比值比 [OR] 8.88，95% 置信区间 [CI] 1.94-42.68，p < 0.05）。然而，更常用的 TBI 严重程度测量方法，例如格拉斯哥昏迷量表、损伤严重程度量表和马歇尔分类，与 TBI 后 MODS 无关。此外，白细胞介素 (IL)-6、IL-8 和 IL-10 的初始血浆浓度与 MODS 的发生显着相关（IL-6 的 OR 1.47，95% CI 1.20-1.80，p < 0.001；IL-8 的 OR 1.26，95% CI 1.01-1.58，p = 0.042；OR 1.77， 95% CI 1.24-2.53，对于 IL-10，p = 0.002）以及个体器官功能障碍（SOFA 成分评分 >= 1）。最后，TBI 后的 MODS 与死亡率显着相关（OR 5.95，95% CI 2.18-19.14，p = 0.001），并且当作为连续变量进行分析时，SOFA 评分与 6 个月时的不良结局显着相关（格拉斯哥结果量表评分 < 4）（OR 1.21，95% CI 1.06-1.40，p = 0.006). 结论 入院影响不良结局的概率以及 IL-6、IL-8 和 IL-10 的初始血浆浓度与 TBI 后的 MODS 相关。
OBJECTIVE Traumatic brain injury (TBI) is a major cause of morbidity and mortality. Multiple organ dysfunction syndrome (MODS) occurs frequently after TBI and independently worsens outcome. The present study aimed to identify potential admission characteristics associated with post-TBI MODS.METHODS The authors performed a secondary analysis of a recent randomized clinical trial studying the effects of erythropoietin and blood transfusion threshold on neurological recovery after TBI. Admission clinical, demographic, laboratory, and imaging parameters were used in a multivariable Cox regression analysis to identify independent risk factors for MODS following TBI, defined as maximum total Sequential Organ Failure Assessment (SOFA) score > 7 within 10 days of TBI.RESULTS Two hundred patients were initially recruited and 166 were included in the final analysis. Respiratory dysfunction was the most common nonneurological organ system dysfunction, occurring in 62% of the patients. International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) probability of poor outcome at admission was significantly associated with MODS following TBI (odds ratio [OR] 8.88, 95% confidence interval [CI] 1.94-42.68, p < 0.05). However, more commonly used measures of TBI severity, such as the Glasgow Coma Scale, Injury Severity Scale, and Marshall classification, were not associated with post-TBI MODS. In addition, initial plasma concentrations of interleukin (IL)-6, IL-8, and IL-10 were significantly associated with the development of MODS (OR 1.47, 95% CI 1.20-1.80, p < 0.001 for IL-6; OR 1.26, 95% CI 1.01-1.58, p = 0.042 for IL-8; OR 1.77, 95% CI 1.24-2.53, p = 0.002 for IL-10) as well as individual organ dysfunction (SOFA component score >= 1). Finally, MODS following TBI was significantly associated with mortality (OR 5.95, 95% CI 2.18-19.14, p = 0.001), and SOFA score was significantly associated with poor outcome at 6 months (Glasgow Outcome Scale score < 4) when analyzed as a continuous variable (OR 1.21, 95% CI 1.06-1.40, p = 0.006).CONCLUSIONS Admission IMPACT probability of poor outcome and initial plasma concentrations of IL-6, IL-8, and IL-10 were associated with MODS following TBI.