Serum thioredoxin and in-hospital major adverse events after traumatic brain injury

Coagulopathy prediction in traumatic brain injury

Traumatic brain injury (TBI) represents a significant public health concern. Besides the initial primary injury, a defining point of TBI is causing secondary, delayed damage through inflammatory biochemical processes. Among the complications arising from this inflammatory response, coagulopathy emerges as a critical concern. With an overall prevalence of 32.7 %, TBI-induced coagulopathy significantly contributes to increased mortality rates and unfavorable patient outcomes, through its clinical manifestations, such as progressive hemorrhagic injury (PHI). This chapter investigates biomarkers capable of accurately detecting coagulopathy and PHI in TBI, evaluating their potential utility based on statistical evidence from various studies and exploring their possible association in the biochemical processes guiding or following TBI-induced coagulopathy. Notably, glucose emerges as a standout candidate, exhibiting a sensitivity of 91.5 % and specificity of 87.5 % for predicting coagulopathy. Furthermore, interleukin-33, with a sensitivity of 93.3 % and specificity of 66.7 %, and galectin-3, with a sensitivity of 67.7 % and specificity of 85.5 %, are promising for PHI. Despite these encouraging findings, significant efforts remain necessary to translate biomarker diagnostic utility into clinical practice effectively. Further research and validation studies are imperative to elucidate the intricate biochemical processes underlying TBI-induced coagulopathy and to refine the clinical application of biomarkers for improved patient management and outcomes in real-world settings.

Advances in the Functions of Thioredoxin System in Central Nervous System Diseases

Significance: The thioredoxin system comprises thioredoxin (Trx), thioredoxin reductase (TrxR), and nicotinamide adenine dinucleotide phosphate, besides an endogenous Trx inhibitor, the thioredoxin-interacting protein (TXNIP). The Trx system plays critical roles in maintaining the redox homeostasis in the central nervous system (CNS), in which oxidative stress damage is prone to occurrence due to its high-energy demand. Recent Advances: Increasing studies have demonstrated that the expression or activity of Trx/TrxR is usually decreased and that TXNIP expression is increased in patients with CNS diseases, including neurodegenerative diseases, cerebral ischemia, traumatic brain injury, and depression, as well as in their cellular and animal models. The compromise of Trx/TrxR enhances the susceptibility of neurons to related pathological state. Increased TXNIP not only enhances the inhibition of Trx activity, but also activates the NOD-like receptor protein 3 inflammasome, resulting in neuroinflammation in the brain. Critical Issues: In this review, we highlight the sources of oxidative stress in the CNS. The expression and function of the Trx system are summarized in different CNS diseases. This review also mentions that some inducers of Trx show neuroprotection in CNS diseases. Future Directions: Accumulating evidence has demonstrated the important roles of the Trx system in CNS diseases, suggesting that the Trx system may be a promising therapeutic target for CNS diseases. Further study should aim to develop the most effective inducers of Trx and specific inhibitors of TXNIP and to apply them in the clinical trials for the treatment of CNS diseases. Antioxid. Redox Signal. 38, 425-441.

Blood biomarkers for predicting coagulopathy occurrence in patients with traumatic brain injury: a systematic review

Purpose: The occurrence of coagulopathy in patients with traumatic brain injury (TBI) is related to severe complications. The authors performed the first systematic review to investigate whether biomarkers can predict the occurrence of hypocoagulopathy or progressive hemorrhagic injury in patients with TBI. Methods: The authors included studies that performed a receiver operating characteristics analysis for the biomarker and provided a clear value along with the respective sensitivity and specificity. Additionally, they attempted to classify each biomarker, taking into account its physiological role. Results: Twelve studies were included. All biomarkers were protein molecules, except in one study that examined the prognostic role of glucose. Copeptin had the highest sensitivity, and S100A12 had the highest specificity in predicting coagulopathy, while IL-33 had the highest sensitivity and GALECTIN-3 had the highest specificity in predicting progressive hemorrhagic injury. Conclusion: The study of the role of biomarkers in predicting the occurrence of coagulopathy in patients with TBI remains in its infancy.

Serum CXC chemokine ligand-12 as a potential predictor for in-hospital major adverse events after severe traumatic brain injury

BACKGROUND

CXC chemokine ligand-12 (CXCL12) is associated with brain inflammation. We attempted to discern whether serum CXCL12 is a promising predictor for in-hospital major adverse events (IMAEs) after traumatic brain injury (TBI), including death, acute lung injury, acute traumatic coagulopathy, progressive hemorrhagic injury and posttraumatic cerebral infarction.

METHODS

In this prospective, observational study, serum CXCL12 levels were quantified among 117 severe TBI patients. We investigated the relation of CXCL12 levels to IMAEs using a multivariate analysis.

RESULTS

Median value of serum CXCL12 concentrations was substantially higher in patients with IMAEs than in other remainders (21.1 vs. 11.6 ng/ml). With an increasing number of IMAEs, serum CXCL12 concentrations were significantly increased (r = 0.702). Serum CXCL12 independently predicted IMAEs (odds ratio, 1.253; 95% CI, 1.100-1.428). Serum CXCL12 concentrations discriminated risk of IMAEs with area under receiver operating characteristic curve of 0.759 (95% CI, 0.672-0.834), its concentrations >16.0 ng/ml distinguished IMAEs with 83.9% sensitivity and 67.2% specificity and its combination with Glasgow coma scale scores produced the best predictive ability compared with each one alone (p = 0.0116 or 0.0004).

CONCLUSION

Serum CXCL12 concentrations are independently associated with IMAEs following TBI, substantializing serum CXCL12 as a useful prognostic biomarker for head trauma patients.