Zhang Han, Lv Qing-Wei, Zheng Zi-Qiang, Shen Liang-Jun, Zhou Jing, Guo Mi
Department of Neurosurgery, Shengzhou People's Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shengzhou, People's Republic of China.
Neuropsychiatr Dis Treat. 2023 Jan 18;19:153-169. doi: 10.2147/NDT.S396771. eCollection 2023.
T cell immunoglobulin and mucin domain-3 (Tim-3) may be implicated in neuroinflammation. Herein, we attempted to discern the role of serum soluble (s) Tim-3 as an inflammatory prognostic biomarker of severe traumatic brain injury (sTBI).
In this prospective observational study of 112 sTBI patients and 112 controls, serum sTim-3 levels were determined, Rotterdam computed tomography (CT) classification and Glasgow coma scale (GCS) were selected as the two severity indicators, serum C-reactive protein (CRP) was regarded as an inflammatory biomarker, and poor prognosis was referred to as extended Glasgow outcome scale (GOSE) scores 1-4 at 180 days after trauma.
Serum sTim-3 levels were markedly higher in patients than in controls (median, 4.2 ng/mL versus 0.7 ng/mL; P<0.001). Serum sTim-3 levels of patients were independently related to Rotterdam CT scores (β=1.126), GCS scores (β=-0.589), serum CRP levels (β=0.155) and GOSE scores (β=-0.211). Serum sTim-3 appeared as an independent predictor of post-traumatic 180-day mortality (odds ratio=1.289), overall survival (hazard ratio=1.208) and poor prognosis (odds ratio=1.293). Serum sTim-3 levels discriminated patients at risk of post-injury 180-day mortality and poor prognosis with areas under curve (AUCs) at 0.753 and 0.782, respectively. Serum sTim-3 levels combined with GCS scores and Rotterdam CT scores (AUC=0.869) exhibited significantly higher AUC than Rotterdam CT scores (P=0.026), but not than GCS scores (P=0.181) for death prediction and their combination (AUC=0.895) had significantly higher AUC than GCS scores (P=0.036) or Rotterdam CT scores (P=0.005) for outcome prediction.
Elevated serum sTim-3 levels, in close correlation with traumatic severity and inflammation, are substantially associated with long-term death and poor outcome, indicating that serum sTim-3, as an inflammatory biomarker, may be of clinical significance in severity assessment and prediction of prognosis following sTBI.
T细胞免疫球蛋白黏蛋白结构域3（Tim-3）可能与神经炎症有关。在此，我们试图明确血清可溶性（s）Tim-3作为重度创伤性脑损伤（sTBI）炎症预后生物标志物的作用。
在这项对112例sTBI患者和112例对照的前瞻性观察研究中，测定血清sTim-3水平，选择鹿特丹计算机断层扫描（CT）分类和格拉斯哥昏迷量表（GCS）作为两个严重程度指标，将血清C反应蛋白（CRP）视为炎症生物标志物，将预后不良定义为创伤后180天时扩展格拉斯哥预后量表（GOSE）评分为1 - 4分。
患者血清sTim-3水平显著高于对照组（中位数，4.2 ng/mL对0.7 ng/mL；P<0.001）。患者血清sTim-3水平与鹿特丹CT评分（β=1.126）、GCS评分（β=-0.589）、血清CRP水平（β=0.155）和GOSE评分（β=-0.211）独立相关。血清sTim-3是创伤后180天死亡率（比值比=1.289）、总生存期（风险比=1.208）和预后不良（比值比=1.293）的独立预测指标。血清sTim-3水平分别以0.753和0.782的曲线下面积（AUC）区分有创伤后180天死亡风险和预后不良的患者。血清sTim-3水平与GCS评分和鹿特丹CT评分联合（AUC=0.869）在死亡预测方面的AUC显著高于鹿特丹CT评分（P=0.026），但不高于GCS评分（P=0.181），其联合（AUC=0.895）在预后预测方面的AUC显著高于GCS评分（P=0.036）或鹿特丹CT评分（P=0.005）。
血清sTim-3水平升高与创伤严重程度和炎症密切相关，与长期死亡和不良预后密切相关，表明血清sTim-3作为一种炎症生物标志物，在sTBI严重程度评估和预后预测中可能具有临床意义。
