Quantification of Alcohol Dehydrogenase Concentration for Traumatic Brain Injury in Alcohol-intoxicated Patients as a Predictor of Severity and Prognosis

Abstract

BACKGROUND: Traumatic brain injury (TBI) stills the leading cause of public health problem and disabilities in many countries, especially in lower-middle-income countries. Motor vehicle crashes, especially motorized two-wheeler riders, are the major cause of TBI, followed by fall and assault. During 2013–2014, a total of 2108 TBI cases (65.4% of them being caused by motor vehicle crashes) were documented in the Emergency Unit of Dr. Hasan Sadikin Hospital (RSHS) Bandung. Among these, 30.7% of cases were categorized as moderate and severe TBI, with a mortality rate of 29.2%. Half of the cases arrived at RSHS within 6 h and 14.0% of these cases were alcohol-intoxicated. Individuals with low activity of alcohol-metabolizing enzymes have low tolerance to alcohol and are therefore rapidly intoxicated, making them more susceptible to more serious injuries from motor vehicle crashes. METHODS: A prospective study was designed by consecutive sampling from January to August 2017 to review 30 intoxicated patients with TBI on hospital admission by measuring their serum alcohol dehydrogenase (ADH) concentration using an ELISA and then correlated it with the severity, type of TBI lesions, and the outcome. RESULTS: Demonstrated an ADH level of l d0.24 ng/ml in patients with TBI with a history of alcohol intoxication, which statistically correlated with lower initial Glasgow coma scale (GCS) scores on admission by approximately 6.53 times (p < 0.001), thus increasing the risk of developing multiple lesions by 3.98 times (p = 0.029) and worse outcomes by 5.27 times (p = 0.003), but it did not correlate with length of stay (p = 0.392). CONCLUSIONS: ADH concentrations in intoxicated TBI patients can be taken into consideration to decide about the therapeutic action and further informed consent to the family.