Serum substance P levels are associated with severity and mortality in patients with severe traumatic brain injury View Full Text


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Article Info

DATE

2015-12-01

AUTHORS

Leonardo Lorente, María M Martín, Teresa Almeida, Mariano Hernández, Luis Ramos, Mónica Argueso, Juan J Cáceres, Jordi Solé-Violán, Alejandro Jiménez

ABSTRACT

IntroductionSubstance P (SP) is a member of the tachykinin family of neuropeptides, which are widely distributed throughout the central nervous system (CNS) and actively involved in inflammatory processes. SP is released early following acute injury to the CNS, promoting a neurogenic inflammatory response characterized by an increase in the permeability of the blood–brain barrier and the development of vasogenic edema. High levels of SP could lead to an exacerbated inflammatory response that could be fatal for patients with traumatic brain injury (TBI). Thus, the main goal of the present study was to determine whether serum SP levels are associated with injury severity and mortality in patients with severe TBI.MethodsThis multicenter, observational, prospective study was carried out in six Spanish intensive care units and included patients with Glasgow Coma Scale (GCS) scores ≤8. Patients with an Injury Severity Score ≥10 in non-cranial aspects were excluded. Blood samples were collected on day 1 of TBI to measure serum SP levels. The endpoint was 30-day mortality.ResultsWe found higher serum SP levels (P =0.002) in non-surviving patients (n =27) than in surviving patients (n =73). The area under the curve for serum SP levels with regard to predicting 30-day mortality was 0.70 (95% confidence interval (CI), 0.60 to 0.79; P <0.001). Survival analysis showed that patients with serum SP levels >299 pg/ml had higher 30-day mortality than patients with lower levels (hazard ratio =3.7; 95% CI, 1.75 to 7.94; P <0.001). Multiple binomial logistic regression analysis showed that serum SP levels >299 pg/ml were associated with 30-day mortality when we controlled for APACHE II score and Marshall computed tomography lesion classification (odds ratio (OR) =5.97; 95% CI, 1.432 to 24.851; P =0.01) and for GCS score and age (OR =5.71; 95% CI, 1.461 to 22.280; P =0.01). We found a negative association between serum SP levels and GCS score (Spearman’s ρ = −0.22; P =0.03).ConclusionsWe report, for the first time to our knowledge, that serum SP levels were associated with injury severity and mortality in patients with severe TBI. These results open the possibility that SP antagonists may be useful in the treatment of patients with severe TBI. More... »

PAGES

192

Journal

TITLE

Critical Care

ISSUE

1

VOLUME

19

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s13054-015-0911-z

DOI

http://dx.doi.org/10.1186/s13054-015-0911-z

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1039626441

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/25928056


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    "description": "IntroductionSubstance P (SP) is a member of the tachykinin family of neuropeptides, which are widely distributed throughout the central nervous system (CNS) and actively involved in inflammatory processes. SP is released early following acute injury to the CNS, promoting a neurogenic inflammatory response characterized by an increase in the permeability of the blood\u2013brain barrier and the development of vasogenic edema. High levels of SP could lead to an exacerbated inflammatory response that could be fatal for patients with traumatic brain injury (TBI). Thus, the main goal of the present study was to determine whether serum SP levels are associated with injury severity and mortality in patients with severe TBI.MethodsThis multicenter, observational, prospective study was carried out in six Spanish intensive care units and included patients with Glasgow Coma Scale (GCS) scores \u22648. Patients with an Injury Severity Score \u226510 in non-cranial aspects were excluded. Blood samples were collected on day 1 of TBI to measure serum SP levels. The endpoint was 30-day mortality.ResultsWe found higher serum SP levels (P =0.002) in non-surviving patients (n =27) than in surviving patients (n =73). The area under the curve for serum SP levels with regard to predicting 30-day mortality was 0.70 (95% confidence interval (CI), 0.60 to 0.79; P <0.001). Survival analysis showed that patients with serum SP levels >299\u00a0pg/ml had higher 30-day mortality than patients with lower levels (hazard ratio =3.7; 95% CI, 1.75 to 7.94; P <0.001). Multiple binomial logistic regression analysis showed that serum SP levels >299\u00a0pg/ml were associated with 30-day mortality when we controlled for APACHE II score and Marshall computed tomography lesion classification (odds ratio (OR) =5.97; 95% CI, 1.432 to 24.851; P =0.01) and for GCS score and age (OR =5.71; 95% CI, 1.461 to 22.280; P =0.01). We found a negative association between serum SP levels and GCS score (Spearman\u2019s \u03c1\u2009=\u2009\u22120.22; P =0.03).ConclusionsWe report, for the first time to our knowledge, that serum SP levels were associated with injury severity and mortality in patients with severe TBI. These results open the possibility that SP antagonists may be useful in the treatment of patients with severe TBI.", 
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25 schema:description IntroductionSubstance P (SP) is a member of the tachykinin family of neuropeptides, which are widely distributed throughout the central nervous system (CNS) and actively involved in inflammatory processes. SP is released early following acute injury to the CNS, promoting a neurogenic inflammatory response characterized by an increase in the permeability of the blood–brain barrier and the development of vasogenic edema. High levels of SP could lead to an exacerbated inflammatory response that could be fatal for patients with traumatic brain injury (TBI). Thus, the main goal of the present study was to determine whether serum SP levels are associated with injury severity and mortality in patients with severe TBI.MethodsThis multicenter, observational, prospective study was carried out in six Spanish intensive care units and included patients with Glasgow Coma Scale (GCS) scores ≤8. Patients with an Injury Severity Score ≥10 in non-cranial aspects were excluded. Blood samples were collected on day 1 of TBI to measure serum SP levels. The endpoint was 30-day mortality.ResultsWe found higher serum SP levels (P =0.002) in non-surviving patients (n =27) than in surviving patients (n =73). The area under the curve for serum SP levels with regard to predicting 30-day mortality was 0.70 (95% confidence interval (CI), 0.60 to 0.79; P <0.001). Survival analysis showed that patients with serum SP levels >299 pg/ml had higher 30-day mortality than patients with lower levels (hazard ratio =3.7; 95% CI, 1.75 to 7.94; P <0.001). Multiple binomial logistic regression analysis showed that serum SP levels >299 pg/ml were associated with 30-day mortality when we controlled for APACHE II score and Marshall computed tomography lesion classification (odds ratio (OR) =5.97; 95% CI, 1.432 to 24.851; P =0.01) and for GCS score and age (OR =5.71; 95% CI, 1.461 to 22.280; P =0.01). We found a negative association between serum SP levels and GCS score (Spearman’s ρ = −0.22; P =0.03).ConclusionsWe report, for the first time to our knowledge, that serum SP levels were associated with injury severity and mortality in patients with severe TBI. These results open the possibility that SP antagonists may be useful in the treatment of patients with severe TBI.
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31 schema:keywords APACHE II score
32 GCS score
33 Glasgow Coma Scale score
34 II score
35 Injury Severity Score
36 Marshall
37 MethodsThis multicenter
38 Multiple binomial logistic regression analysis
39 P levels
40 ResultsWe
41 SP antagonist
42 SP levels
43 Scale score
44 Spanish intensive care units
45 acute injury
46 age
47 analysis
48 antagonist
49 area
50 aspects
51 association
52 barriers
53 binomial logistic regression analysis
54 blood samples
55 blood-brain barrier
56 brain injury
57 care unit
58 central nervous system
59 classification
60 curves
61 day 1
62 development
63 edema
64 endpoint
65 family
66 first time
67 goal
68 high levels
69 increase
70 inflammatory process
71 inflammatory response
72 injury
73 injury severity
74 intensive care unit
75 knowledge
76 lesion classification
77 levels
78 logistic regression analysis
79 low levels
80 main goal
81 members
82 mortality
83 multicenter
84 negative association
85 nervous system
86 neurogenic inflammatory response
87 neuropeptides
88 non-cranial aspects
89 non-surviving patients
90 patients
91 permeability
92 pg/
93 possibility
94 present study
95 process
96 prospective study
97 regard
98 regression analysis
99 report
100 response
101 results
102 samples
103 scores
104 serum SP levels
105 serum substance P levels
106 severe traumatic brain injury
107 severity
108 severity score
109 sp
110 study
111 substance P levels
112 survival analysis
113 system
114 tachykinin family
115 time
116 traumatic brain injury
117 treatment
118 treatment of patients
119 units
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