Intensive Care Unit, Hospital Universitario de Canarias, Ofra s/n, La Laguna, Santa Cruz de Tenerife, 38320, Spain.
Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Crta del Rosario s/n, Santa Cruz de Tenerife, 38010, Spain.
Anaesth Crit Care Pain Med. 2021 Dec;40(6):100966. doi: 10.1016/j.accpm.2021.100966. Epub 2021 Oct 27.
A secondary brain injury could appear after traumatic brain injury (TBI) due to neuroinflammation, oxidation and apoptosis. Higher levels of serum melatonin have been found on admission for TBI in non-surviving than in surviving patients. Thus, the objective of this study was to know serum melatonin levels during the first week of TBI in surviving and non-surviving patients, and to know if serum melatonin levels during the first week of TBI can be used to predict mortality.
Patients with an isolated and severe TBI were included; that is, if they scored < 10 points in non-cranial aspects of Injury Severity Score and < 9 points in the Glasgow Coma Scale. We measured serum melatonin concentrations at days 1, 4 and 8 of TBI. Thirty-day mortality was the end-point study.
Lower serum melatonin levels were found in the surviving patients (n = 90) than in the non-survivors (n = 34) on days 1 (p < 0.001), 4 (p < 0.001), and 8 (p = 0.02) of TBI. Serum melatonin concentrations on days 1, 4, and 8 of TBI had an area under curve (95% Confidence Interval) for the prediction of 30-day mortality of 0.85 (0.77-0.91; p < 0.001), 0.82 (0.74-0.89; p < 0.001) and 0.71 (0.61-0.79; p = 0.06) respectively.
The new findings of this study were the presence of higher levels of serum melatonin on days 1, 4 and 8 of TBI in non-survivors than in survivors, and the ability to predict 30-day mortality for serum melatonin levels measured at these time points. However, more research is necessary to confirm our results.
继发性脑损伤可能由于神经炎症、氧化和细胞凋亡而在创伤性脑损伤（TBI）后出现。在 TBI 患者中，入院时血清褪黑素水平较高的非幸存者比幸存者高。因此，本研究的目的是了解 TBI 存活和非存活患者在发病第一周的血清褪黑素水平，并了解 TBI 发病第一周的血清褪黑素水平是否可用于预测死亡率。
纳入了孤立性严重 TBI 患者；即，如果他们的损伤严重程度评分（ISS）非颅部分<10 分，格拉斯哥昏迷量表（GCS）<9 分。我们在 TBI 第 1、4 和 8 天测量血清褪黑素浓度。30 天死亡率是本研究的终点。
TBI 第 1、4 和 8 天，存活患者（n=90）的血清褪黑素水平低于非存活患者（n=34）（p<0.001）。TBI 第 1、4 和 8 天的血清褪黑素浓度对 30 天死亡率的预测的曲线下面积（95%置信区间）分别为 0.85（0.77-0.91；p<0.001）、0.82（0.74-0.89；p<0.001）和 0.71（0.61-0.79；p=0.06）。
本研究的新发现是，在 TBI 第 1、4 和 8 天，非幸存者的血清褪黑素水平高于幸存者，并且可以通过测量这些时间点的血清褪黑素水平来预测 30 天死亡率。然而，需要进一步的研究来证实我们的结果。
