Geneva Neuroscience Center, University of Geneva, Geneva, Switzerland.
Scand J Trauma Resusc Emerg Med. 2012 Dec 18;20:83. doi: 10.1186/1757-7241-20-83.
The relationship between severe traumatic brain injury (TBI) and blood levels of matrix metalloproteinase-9 (MMP-9) or cellular fibronectin (c-Fn) has never been reported. In this study, we aimed to assess whether plasma concentrations of MMP-9 and c-Fn could have predictive values for the composite endpoint of intensive care unit (ICU) length of stay (LOS) of survivors and mortality after severe TBI. Secondary outcomes were the state of consciousness measured with the Glasgow Coma Scale (GCS) of survivors at 14 days and Glasgow Outcome Scale Extended (GOSE) at 3 months.
Forty-nine patients with abbreviated injury scores of the head region ≥ 4 were included. Blood was sampled at 6, 12, 24 and 48 hours after injury. MMP-9 and c-Fn concentrations were measured by ELISA. The values of MMP-9 and c-Fn, and, for comparison, the value of the GCS on the field of the accident (fGCS), as predictors of the composite outcome of ICU LOS and death were assessed by logistic regression.
There was a linear relationship between maximal MMP-9 concentration, measured during the 6-12-hour period, and maximal c-Fn concentration, measured during the 24-48-hour period. The risk of staying longer than 9 days in the ICU or of dying was increased in patients with a maximal early MMP-9 concentration ≥ 21.6 ng/ml (OR = 5.0; 95% CI: 1.3 to 18.6; p = 0.02) or with a maximal late c-Fn concentration ≥ 7.7 μg/ml (OR = 5.4; 95% CI: 1.4 to 20.8; p = 0.01). A similar risk association was observed with fGCS ≤8 (OR, 4.4; 95% CI, 1.2-15.8; p = 0.02). No relationship was observed between MMP-9, c-Fn concentrations or fGCS and the GCS at 14 days of survivors and GOSE at 3 months.
Plasma MMP-9 and c-Fn concentrations in the first 48 hours after injury are predictive for the composite endpoint of ICU LOS and death after severe TBI but not for consciousness at 14 days and outcome at 3 months.
严重创伤性脑损伤（TBI）与基质金属蛋白酶-9（MMP-9）或细胞纤维连接蛋白（c-Fn）的血液水平之间的关系从未被报道过。在这项研究中，我们旨在评估血浆 MMP-9 和 c-Fn 浓度是否对幸存者重症监护病房（ICU）入住时间（LOS）和严重 TBI 后死亡率的复合终点具有预测值。次要结局是幸存者在 14 天时用格拉斯哥昏迷量表（GCS）和在 3 个月时用格拉斯哥结局量表扩展（GOSE）测量的意识状态。
纳入了头部损伤严重程度评分≥4 的 49 名患者。在受伤后 6、12、24 和 48 小时采集血液样本。通过 ELISA 测量 MMP-9 和 c-Fn 浓度。通过逻辑回归评估 MMP-9 和 c-Fn 的值（以及事故现场 GCS 值（fGCS）的比较值）作为 ICU LOS 和死亡复合结局的预测因子。
在 6-12 小时期间测量的最大 MMP-9 浓度与在 24-48 小时期间测量的最大 c-Fn 浓度之间存在线性关系。在最大早期 MMP-9 浓度≥21.6ng/ml（OR=5.0；95%CI：1.3 至 18.6；p=0.02）或最大晚期 c-Fn 浓度≥7.7μg/ml（OR=5.4；95%CI：1.4 至 20.8；p=0.01）的患者中，ICU 入住时间超过 9 天或死亡的风险增加。类似的风险关联也观察到 fGCS≤8（OR，4.4；95%CI，1.2-15.8；p=0.02）。MMP-9、c-Fn 浓度或 fGCS 与幸存者在 14 天时的 GCS 和在 3 个月时的 GOSE 之间没有关系。
受伤后 48 小时内的血浆 MMP-9 和 c-Fn 浓度可预测严重 TBI 后 ICU LOS 和死亡的复合终点，但不能预测 14 天时的意识和 3 个月时的结局。
