Elsevier

Journal of Critical Care

Volume 27, Issue 5, October 2012, Pages 527.e1-527.e6
Journal of Critical Care

Biomarkers/Outcome
Decreased plasma gelsolin is associated with 1-year outcome in patients with traumatic brain injury,☆☆

https://doi.org/10.1016/j.jcrc.2012.01.002Get rights and content

Abstract

Purpose

Decreased plasma gelsolin level has been associated with 1-month mortality after traumatic brain injury (TBI). Thus, we investigated the ability of gelsolin to predict 1-year mortality and functional outcome in these patients.

Methods

One hundred fourteen healthy controls and 114 patients with acute severe TBI were included in this study. Plasma gelsolin concentration on admission was measured by ELISA.

Results

Fifty-five patients (48.2%) had unfavorable outcome (Glasgow Outcome Scale score of 1-3) and 38 patients (33.3%) died in 1 year after TBI. Upon admission, plasma gelsolin level in patients was substantially lower than that in healthy controls. A multivariate analysis selected plasma gelsolin level as an independent predictor for 1-year unfavorable outcome and mortality of patients. A receiver operating characteristic curve analysis showed plasma gelsolin level predicted 1-year unfavorable outcome and mortality statistically significantly. The predictive value of the gelsolin concentration was thus similar to that of Glasgow Coma Scale (GCS) score. In a combined logistic-regression model, gelsolin did not statistically significantly improve the area under curve of GCS score.

Conclusions

Plasma gelsolin level is a useful, complementary tool to predict functional outcome and mortality 1 year after TBI.

Introduction

Plasma gelsolin is the extracellular isoform of a ubiquitous cytoplasmic actin-binding protein, gelsolin, which mediates cell shape changes and motility [1]. Plasma gelsolin is associated with the severity and outcome of critical illness, and therefore, has been proposed as a prognostic marker in acute illness [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]. Recently, it has been reported that plasma gelsolin levels were also decreased in the patients with traumatic brain injury (TBI) [12] and ischemic stroke [13]; in these groups of patients, low gelsolin levels were highly predictive for 1-month mortality. Thus, the present study aimed to investigate the usefulness of gelsolin as a predictor of 1-year functional outcome and mortality in TBI.

Section snippets

Study population

From April 2008 to July 2010, all isolated head trauma patients with a postresuscitation Glasgow Coma Scale (GCS) score of 8 or less were initially assessed. Exclusion criteria were younger than 18 years, admission time greater than 6hours, previous head trauma, neurological disease including ischemic or hemorrhagic stroke, use of antiplatelet or anticoagulant medication, and presence of other previous systemic diseases including uremia, liver cirrhosis, malignancy, chronic heart or lung

Patient characteristics

During the study period, 138 patients with an isolated head trauma diagnosis were admitted to Department of Neurosurgery, the Affiliated Taizhou Municipal Hospital, Taizhou University. Of these, 24 were excluded for the following reasons: younger than 18 years (n = 3), admission time longer than 6 hours (n = 5), previous head trauma (n = 2), previous ischemic or hemorrhagic stroke (n = 3), use of antiplatelet or anticoagulant medication (n = 4), presence of other systemic diseases (n = 7), or

Discussion

In this post hoc analysis of prospective collected data, we demonstrated that plasma gelsolin levels on admission in the patients were significantly lower than those in healthy controls, and in patients who had poor functional outcome or died in a year, the gelsolin levels on admission were significantly lower compared with levels in survivors or those with good functional outcome. In multivariate logistic regression models of predictors of death and poor functional outcome, the gelsolin levels

Conclusions

In this study, decreased plasma gelsolin levels are association with 1-year functional outcome and mortality after TBI.

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  • Cited by (0)

    Competing interests: None.

    ☆☆

    Institution at which the work was performed: Affiliated Taizhou Municipal Hospital, Taizhou University.

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