Serum adhesion molecules, outcome and neuro-psychological function in acute traumatic brain injury patients

Background: Serum concentrations of adhesion molecules may be associated with secondary brain injury after acute traumatic brain injury (TBI).

Methods: Blood samples of 68 patients admitted within 24h after TBI were obtained on admission and on Days 4 and 7 after TBI. Patients received neuro-psychological testing on discharge and at 3 months after TBI.

Results: Compared to controls, patients with acute TBI had markedly increased sICAM-1 and sVCAM-1 on presentation (p=0.002 and p=0.021, respectively), but markedly decreased sL-selectin and sE-selectin (p=0.009 and p≤0.001, respectively). Outcome was assessed upon discharge using the Glasgow Outcome Scale (GOS). Good outcome was defined as GOS ≥4 and poor outcome as GOS ≤3. Motor deficits on admission (p≤0.001), Glasgow Coma Scale score on admission (p=0.002), Injury Severity Score on admission (p=0.009), neuro-surgical intervention (p=0.004), post-traumatic seizure (p=0.04), and sVCAM-1 level on admission (p=0.033) were significant risk factors of outcome. A sVCAM-1 cut-off value of 752.5ng/ml on admission had 80.0% sensitivity and 68.1% specificity for predicting outcome.

Conclusion: Serum adhesion molecules are not specific for predicting outcome in patients with TBI. However, higher mean levels of these molecules on admission may imply more severe inflammatory response causing secondary brain injury and worse neuro-psychological function. These molecules may be added as evaluation markers in clinical practice.