Lekuya Hervé Monka, Cose Stephen, Nakibuule Marjorie, Ahimbisibwe Gift, Fuller Anthony, Kamabu Larrey Kasereka, Biryabarema Emmanuel, Olweny Geoffrey, Kateete David Patrick, Kirabira Anthony, Makumbi Fredrick, Vandersteene Jelle, Baert Edward, Galukande Moses, Kalala Jean-Pierre Okito
Department of Surgery, College of Health Sciences, Makerere University, Kampala, Uganda.
Department of Human Repair, Neurosurgery, Ghent University, Ghent, Belgium.
Front Neurol. 2024 Dec 18;15:1484742. doi: 10.3389/fneur.2024.1484742. eCollection 2024.
The safe timing window for surgery during the acute phase of inflammation due to traumatic brain injury (TBI) has not been studied extensively. We aimed to elucidate the relationship between the timing of surgery and changes in perioperative serum levels of inflammatory cytokines and factors associated to optimize TBI management in low-middle-income countries.
A prospective cohort study was conducted among TBI Patients with depressed skull fractures with a GCS > 8 operated at different timing from injury and followed up peri-operatively. We collected the clinical-radiological data, as well as pre-and postoperative venous samples from participants; we then did Luminex Assay to quantify the serum levels of pro/anti-inflammatory cytokines using the kits of 96-well human cytokine "27-Plex-Assay (#M500KCAF0Y®)." We performed the analysis with STATA version 17 and R_studio applying both descriptive and inferential methods.
We enrolled 82 TBI patients with a median (IQR) age of 25.5 (20-34) years, and the majority were male (85.4%). There were 48.8% victims of assaults, and 73.2% had a post-resuscitation admission GCS of 14-15. There were 38 (46.3%) who were operated within 48 h of injury versus 44 (53.7%) after 48 h. Serum levels of TNF- were significantly higher after surgeries done >48 h compared to those done ≤48 h ( = 0.0327); whereas, the difference in post-operative mean serum levels of IL-10 was significantly increased in patients who developed later SSI compared to those who did not (11.56 versus -0.58 pg./mL, = 0.0489). In multivariate analysis, the history of post-traumatic seizure (PTS) was associated with a postoperative increase in TNF- ( = 0.01), the hemoglobin of 10-12 with a postoperative decrease of IL-4 ( = 0.05); the presence of focal neurological deficit was associated with a significant postoperative increased of TNF-α, IL-6, and IL-4 ( = 0.05). The presence of extra-axial hemorrhage was associated with a postoperative increase of IL-10 ( = 0.05).
Delayed surgical intervention beyond 48 h post-injury in mild-moderate TBI patients results in a significantly increased postoperative inflammatory response, as evidenced by elevated serum levels of TNF- and IL-6. Neurological deficits, PTS, reduced hemoglobin rate, and extra-axial intracranial hemorrhage are factors associated with this heightened response.
创伤性脑损伤（TBI）急性期手术的安全时间窗尚未得到广泛研究。我们旨在阐明手术时机与围手术期血清炎症细胞因子水平变化之间的关系，以及相关因素，以优化低收入和中等收入国家的TBI管理。
对不同受伤时间接受手术且格拉斯哥昏迷量表（GCS）>8的颅骨凹陷性骨折TBI患者进行前瞻性队列研究，并在围手术期进行随访。我们收集了临床放射学数据以及参与者术前和术后的静脉血样；然后使用96孔人细胞因子“27 - 多重检测试剂盒（#M500KCAF0Y®）”进行Luminex检测，以量化促炎/抗炎细胞因子的血清水平。我们使用STATA 17版和R_studio进行分析，采用描述性和推断性方法。
我们纳入了82例TBI患者，中位（四分位间距）年龄为25.5（20 - 34）岁，大多数为男性（85.4%）。48.8%为袭击受害者，73.2%复苏后入院时GCS为14 - 15。38例（46.3%）在受伤后48小时内接受手术，44例（53.7%）在48小时后接受手术。与≤48小时进行的手术相比，>48小时进行的手术后血清TNF - 水平显著更高（P = 0.0327）；而与未发生迟发性手术部位感染（SSI）的患者相比，发生迟发性SSI的患者术后平均血清IL - 10水平差异显著增加（11.56对 - 0.58 pg/mL，P = 0.0489）。在多变量分析中，创伤后癫痫（PTS）病史与术后TNF - 升高相关（P = 0.01），血红蛋白10 - 12与术后IL - 4降低相关（P = 0.05）；局灶性神经功能缺损与术后TNF - α、IL - 6和IL - 4显著升高相关（P = 0.05）。脑外出血与术后IL - 10升高相关（P = 0.05）。
轻度至中度TBI患者受伤后48小时后延迟手术干预导致术后炎症反应显著增加，血清TNF - 和IL - 6水平升高证明了这一点。神经功能缺损、PTS、血红蛋白率降低和脑外颅内出血是与这种增强反应相关的因素。
