Abstract
BackgroundTraumatic brain injury (TBI) is a major cause of death and disability. In this study a new method to measure cell free DNA (CFD) for the management of TBI is tested. Our hypothesis was that CFD concentrations correlate to the magnitude of brain damage, and may predict the outcome of injured patients.MethodsTwenty eight patients with isolated head injury were enrolled. Their demographic and clinical data were recorded. CFD levels were determined in patients' sera samples by a direct fluorescence method developed in our laboratory.ResultsMean admission CFD values were lower in patients with mild TBI compared to severe injury (760 ± 340 ng/ml vs. 1600 ± 2100 ng/ml, p = 0.03), and in patients with complete recovery upon discharge compared to patients with disabilities (680 ± 260 ng/ml vs. 2000 ± 2300 ng/ml, p = 0.003). Patients with high CFD values had a relative risk to require surgery of 1.5 (95% CI 0.83 to 2.9) a relative risk to have impaired outcome on discharge of 2.8 (95% CI 0.75 – 10), and a longer length of stay (12 ± 13 days vs. 3.4 ± 4.8 days, p = 0.02). CFD values did not correlate with CT scan based grading.ConclusionsCFD levels may be used as a marker to assess the severity of TBI and to predict the prognosis. Its use should be considered as an additional tool along with currently used methods or as a surrogate for them in limited resources environment.
Highlights
Traumatic brain injury (TBI) is a major cause of death and disability
The main results of this study show that cell free DNA (CFD) levels are elevated in TBI patients with Glasgow Coma Scale (GCS) ≤ 13, and in patients with worse outcome as reflected by mortality, poor Glasgow Outcome Score (GOS), prolonged length of stay in the hospital, and with increased risk to require a surgical intervention
In this study we showed that the mean value of admission CFD concentrations in mild head injury (GCS >13) was significantly lower than that of moderate and severe TBI
Summary
Traumatic brain injury (TBI) is a major cause of death and disability. In this study a new method to measure cell free DNA (CFD) for the management of TBI is tested. Macher et al showed that severe TBI is associated with augmented CFD levels, and suggested that early (within 24 hours) CFD concentrations decrease predicts a better outcome [21]. Despite these initial promising results on the value of CFD measurement in TBI patients this scheme has not yet entered into clinical use. The aim of the present study was to evaluate this method for the identification of CFD in TBI patients, and whether it may serve as an additional diagnostic and prognostic tool capable to assist in the management of head injured patients. We hypothesized that CFD concentrations would associate with severity of injury, and that low or high levels could differentiate between good or bad outcome, respectively
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