Yue John K, Ngwenya Laura B, Upadhyayula Pavan S, Deng Hansen, Winkler Ethan A, Burke John F, Lee Young M, Robinson Caitlin K, Ferguson Adam R, Lingsma Hester F, Cnossen Maryse C, Pirracchio Romain, Korley Frederick K, Vassar Mary J, Yuh Esther L, Mukherjee Pratik, Gordon Wayne A, Valadka Alex B, Okonkwo David O, Manley Geoffrey T
Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA.
Department of Neurological Surgery, University of Cincinnati, Cincinnati, OH, USA.
J Clin Neurosci. 2017 Nov;45:293-298. doi: 10.1016/j.jocn.2017.07.022. Epub 2017 Aug 5.
The relationship between blood alcohol level (BAL) and mild traumatic brain injury (mTBI) remains in need of improved characterization. Adult patients suffering mTBI without intracranial pathology on computed tomography (CT) from the prospective Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot study with emergency department (ED) Glasgow Coma Scale (GCS) 13-15 and recorded blood alcohol level (BAL) were extracted. BAL≥80-mg/dl was set as proxy for excessive use. Multivariable regression was performed for patients with six-month Glasgow Outcome Scale-Extended (GOSE; functional recovery) and Wechsler Adult Intelligence Scale Processing Speed Index Composite Score (WAIS-PSI; nonverbal processing speed), using BAL≥80-mg/dl and <80-mg/dl cohorts, adjusting for demographic/injury factors. Overall, 107 patients were aged 42.7±16.8-years, 67.3%-male, and 80.4%-Caucasian; 65.4% had BAL=0-mg/dl, 4.6% BAL<80-mg/dl, and 30.0% BAL≥80-mg/dl (range 100-440-mg/dl). BAL differed across loss of consciousness (LOC; none: median 0-mg/dl [interquartile range (IQR) 0-0], <30-min: 0-mg/dl [0-43], ≥30-min: 224-mg/dl [50-269], unknown: 108-mg/dl [0-232]; p=0.002). GCS<15 associated with higher BAL (19-mg/dl [0-204] vs. 0-mg/dl [0-20]; p=0.013). On univariate analysis, BAL≥80-mg/dl associated with less-than-full functional recovery (GOSE≤7; 38.1% vs. 11.5%; p=0.025) and lower WAIS-PSI (92.4±12.7, 30th-percentile vs. 105.1±11.7, 63rd-percentile; p<0.001). On multivariable regression BAL≥80-mg/dl demonstrated an odds ratio of 8.05 (95% CI [1.35-47.92]; p=0.022) for GOSE≤7 and an adjusted mean decrease of 8.88-points (95% CI [0.67-17.09]; p=0.035) on WAIS-PSI. Day-of-injury BAL>80-mg/dl after uncomplicated mTBI was associated with decreased GCS score and prolongation of reported LOC. BAL may be a biomarker for impaired return to baseline function and decreased nonverbal processing speed at six-months postinjury. Future confirmatory studies are needed.
血液酒精水平（BAL）与轻度创伤性脑损伤（mTBI）之间的关系仍需进一步明确。我们从一项前瞻性的“创伤性脑损伤转化研究与临床知识试点研究”中提取了成年患者的数据，这些患者在计算机断层扫描（CT）上没有颅内病变，患有mTBI，且在急诊科的格拉斯哥昏迷量表（GCS）评分为13 - 15分，并记录了血液酒精水平（BAL）。将BAL≥80mg/dl设定为过量饮酒的指标。对使用BAL≥80mg/dl和<80mg/dl两组队列的患者进行多变量回归分析，以六个月的格拉斯哥预后量表扩展版（GOSE；功能恢复情况）和韦氏成人智力量表加工速度指数综合评分（WAIS - PSI；非语言加工速度）为指标，并对人口统计学/损伤因素进行校正。总体而言，107例患者年龄为42.7±16.8岁，67.3%为男性，80.4%为白种人；65.4%的患者BAL = 0mg/dl，4.6%的患者BAL<80mg/dl，30.0%的患者BAL≥80mg/dl（范围为100 - 440mg/dl）。BAL在意识丧失（LOC）情况不同的患者中存在差异（无：中位数0mg/dl [四分位间距（IQR）0 - 0]，<30分钟：0mg/dl [0 - 43]，≥30分钟：224mg/dl [50 - 269]，未知：108mg/dl [0 - 232]；p = 0.002）。GCS<15分与较高的BAL相关（19mg/dl [0 - 204] 对比 0mg/dl [0 - 20]；p = 0.013）。单因素分析显示，BAL≥80mg/dl与功能未完全恢复（GOSE≤7；38.1% 对比 11.5%；p = 0.025）以及较低的WAIS - PSI（92.4±12.7，第30百分位数 对比 105.1±11.7，第63百分位数；p<0.001）相关。多变量回归分析显示，对于GOSE≤7，BAL≥80mg/dl的优势比为8.05（95%置信区间[1.35 - 47.92]；p = 0.022），在WAIS - PSI上调整后的平均降低值为8.88分（95%置信区间[0.67 - 17.09]；p = 0.035）。单纯性mTBI后损伤当天BAL>80mg/dl与GCS评分降低和报告的LOC延长相关。BAL可能是损伤后六个月功能恢复至基线水平受损和非语言加工速度降低的生物标志物。未来需要进行验证性研究。
