Anesthesia Department.
Chemical and Clinical Pathology Department.
J Neurosurg Anesthesiol. 2021 Jul 1;33(3):254-257. doi: 10.1097/ANA.0000000000000647.
Biomarkers can assist in outcome prediction and therapeutic decision making after traumatic brain injury (TBI). The aim of this study was to evaluate the role of ischemia-modified albumin (IMA) in the prediction of mortality in patients with TBI.
In this observational study IMA was measured on admission to intensive care unit (D0) and 24 hours later (D1) in a cohort of patients with mixed TBI severity. The primary outcome was the correlation between IMA and 28-day mortality. Secondary outcomes included the incidence of elevated IMA, and the correlation between the severity of TBI and IMA, and between IMA and change in Glasgow coma score (GCS). The area under receiver operating characteristic curve analysis was performed to detect optimal IMA cut-off value for the detection of mortality.
Fifty-four patients were included in the study; IMA was elevated in 49 (90.7%) on admission to the intensive care unit. Of the 49 patients with elevated IMA, 22 had a decrease in IMA while 27 had an increase by 24 hours. IMA levels were higher at D0 and D1 (P<0.001 for both) in patients who died compared with those who survived. Twenty-one patients died (mortality rate 38.9%); all had elevated IMA on D0 and D1 and higher IMA levels at D1 compared with D0. Optimal cut-off values for IMA predicted mortality with 76.2% sensitivity and 81.8% specificity at D0 and with 100% sensitivity and specificity at D1. IMA values at D0 and D1 were correlated with D0 and D1 GCS, respectively (both P<0.001).
IMA levels were elevated in patients following TBI, and can predict mortality with high sensitivity and specificity.
生物标志物可协助外伤性脑损伤（TBI）后的预后预测和治疗决策。本研究旨在评估缺血修饰白蛋白（IMA）在预测 TBI 患者死亡率中的作用。
在这项观察性研究中，我们在混合 TBI 严重程度的患者队列中，在入住重症监护病房（D0）时和 24 小时后（D1）测量了 IMA。主要结局是 IMA 与 28 天死亡率之间的相关性。次要结局包括 IMA 升高的发生率，以及 TBI 严重程度与 IMA 之间、IMA 与格拉斯哥昏迷评分（GCS）变化之间的相关性。进行了受试者工作特征曲线分析，以检测检测死亡率的最佳 IMA 截断值。
本研究纳入了 54 例患者；入住重症监护病房时，49 例（90.7%）患者的 IMA 升高。在 49 例 IMA 升高的患者中，22 例 IMA 降低，27 例 IMA 升高。与存活患者相比，死亡患者在 D0 和 D1 时的 IMA 水平更高（两者 P<0.001）。21 例患者死亡（死亡率为 38.9%）；所有患者在 D0 和 D1 时 IMA 升高，D1 时 IMA 水平高于 D0。在 D0 和 D1 时，IMA 的最佳截断值预测死亡率的敏感性分别为 76.2%和 81.8%，特异性分别为 100%和 100%。D0 和 D1 时的 IMA 值分别与 D0 和 D1 时的 GCS 相关（均 P<0.001）。
TBI 患者的 IMA 水平升高，可高度敏感和特异性地预测死亡率。
