Abstract 342: Differences in Inflammatory Dysregulation in TBI Versus Major Trauma
Introduction: Up-regulation of aseptic inflammation is a prominent feature of major trauma, with or without head injury. Observational studies in TBI often lack control groups with major trauma, obscuring the genesis of the reported biomarkers. We hypothesized that patients with TBI would display a unique inflammatory signature that would differ from patients with major trauma without brain injury, due to blood-brain-barrier compromise.
Methods: We prospectively enrolled patients with major trauma with and without TBI from a busy level I trauma center ICU. TBI was defined as GCS<13 not related to intoxication, or the presence of intracranial hemorrhage on admission CT scan. Plasma samples were obtained on admission (<8 hours from the trauma), and banked at -80°C for subsequent analysis. Plasma was analyzed by the Stanford Human Immune Monitoring Center using a Luminex human 61-plex analyte platform that screens 61 secreted proteins using multiplex fluorescent immunoassay; samples were run in duplicate for confirmation, and the means reported. Measurements are reported in median [IQR] in pg/mL. P values of 0.05 or less were considered significant, though final data will be adjusted for multiple comparisons.
Results: Forty patients were enrolled, 21 had TBI. Total injury severity scores (ISS) (26 [11-27 v. 14 [10-21] P=0.11) and APACHE (14 [12-24] v. 12 [10-14] P=0.07) scores were comparable between groups. Patients in the TBI group had a lower GCS on admission (15 [4-15] v. 15 [15-15]) P=0.04). While both groups had evidence of elevated cytokines, only TNF-alpha (72.23 [63.68-91.27] v. 63.52 [58.36-69.5], P=0.05) and interferon beta (19.31 [14.13-33.8] v. 14.79 [10.71-17.32], P=0.04) were statistically significantly different between the groups, both more elevated in the TBI group.
Conclusion: Our data provides preliminary evidence of immunologic dissonance unique to TBI as compared to major trauma. Future studies using biomarkers in TBI must control for major trauma as a confounder.
Author Disclosures: H.E. Hinson: Research Grant; Significant; NHBLI Grant Number 1K12HL108974. M. Schreiber: None. C. Morris: None. D. Bourdette: None.
- © 2014 by American Heart Association, Inc.