THE RELATIONSHIP OF SOLUBLE ADHESION MOLECULE CONCENTRATIONS IN SYSTEMIC AND JUGULAR VENOUS SERUM TO INJURY SEVERITY AND OUTCOME AFTER TRAUMATIC BRAIN INJURY
Eg. Mckeating et al., THE RELATIONSHIP OF SOLUBLE ADHESION MOLECULE CONCENTRATIONS IN SYSTEMIC AND JUGULAR VENOUS SERUM TO INJURY SEVERITY AND OUTCOME AFTER TRAUMATIC BRAIN INJURY, Anesthesia and analgesia, 86(4), 1998, pp. 759-765
Adhesion molecules control the migration of leukocytes into tissue aft
er injury. This may result in further cellular damage. We hypothesized
that altered serum concentrations of soluble intercellular adhesion m
olecule (sICAM)-1 and soluble L-selectin (sL-selectin) after traumatic
brain injury would correlate with injury severity and neurological ou
tcome. We investigated serum concentrations of sICAM-1 and sl-selectin
in 22 patients with traumatic brain injury admitted to the intensive
care unit. The Glasgow Coma Scale (GCS) score and Injury Severity Scor
e were recorded. Paired arterial and jugular venous blood samples were
taken on admission and 24, 48, and 96 h after injury. Mean systemic a
nd jugular venous concentrations of sICAM-1 were normal on admission b
ut became significantly increased by 96 h (P = 0.018). sl-selectin con
centrations of injured patients were markedly below those of controls
at all time points (P < 0.001). There were no significant differences
between jugular venous and arterial concentrations of either sICAM-1 o
r sl-selectin. Serum sICAM-1 was significantly related to neurological
outcome (P < 0.001) and to the GCS score (P < 0.001). These changes i
n adhesion molecule expression after acute brain injury may be importa
nt in the pathophysiology of secondary injury. The highly significant
relationship between serum sICAM-1 and neurological outcome suggests t
hat the inflammatory response to injury may be detrimental. Drugs that
antagonize the actions of the adhesion molecules may have a role in t
herapy after traumatic brain injury. Implications: This observational
study shows that there is a strong association between soluble interce
llular adhesion molecule-1 in serum and poor neurological outcome afte
r traumatic brain injury. This suggests that inflammation after brain
injury may worsen the prognosis and that therapies directed against th
is inflammation may prove useful.