Cerebrospinal fluid concentrations of anti-inflammatory mediators in early-phase severe traumatic brain injury.
In our previous study of patients with early-phase severe traumatic brain injury (TBI), the anti-inflammatory interleukin (IL)-10 concentration was lower in cerebrospinal fluid (CSF) than in serum, whereas proinflammatory IL-1beta and tumor necrosis factor (TNF)-alpha concentrations were higher in CSF than in serum. To clarify the influence of additional injury on this disproportion between proinflammatory and anti-inflammatory mediators, we compared their CSF and serum concentrations in patients with severe TBI with and without additional injury. All 35 study patients (18 with and 17 without additional injury) had a Glasgow Coma Scale score of 8 or less upon admission. With the exception of additional injury, clinical characteristics did not differ significantly between groups. CSF and serum concentrations of two proinflammatory mediators (IL-1beta and TNF-alpha,) and three anti-inflammatory mediators (IL-1 receptor antagonist [IL-1ra], soluble TNF receptor-I [sTNFr-I], and IL-10) were measured and compared at 6 h after injury. CSF concentrations of proinflammatory mediators were much higher than the corresponding serum concentrations in both patient groups (P < 0.001). In contrast, serum concentrations of anti-inflammatory mediators were much higher than the paired CSF concentrations in patients with additional injury (P < 0.001), but serum concentrations were lower than or equal to the corresponding CSF concentrations in patients without additional injury. CSF concentrations of IL-1beta, IL-1ra, sTNFr-I, and IL-10 were significantly higher (P < 0.01 for all) in patients with high intracranial pressure (ICP; n = 11) than in patients with low ICP (n = 24), and were also significantly higher (P < 0.05 for all) in patients with an unfavorable outcome (n = 14) than in patients with a favorable outcome (n = 21). These findings indicate that increased serum concentrations of anti-inflammatory mediators after severe TBI are mainly due to additional extracranial injury. We conclude that anti-inflammatory mediators in CSF may be useful indicators of the severity of brain damage in terms of ICP as well as overall prognosis of patients with severe TBI.
Shiozaki
Tadahiko
T
Department of Traumatology, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan. shiozaki@hp-emerg.med.osaka-u.ac.jp
Hayakata
Toshiaki
T
Tasaki
Osamu
O
Hosotubo
Hideo
H
Fuijita
Kieko
K
Mouri
Tomoyoshi
T
Tajima
Goro
G
Kajino
Kentaro
K
Nakae
Haruhiko
H
Tanaka
Hiroshi
H
Shimazu
Takeshi
T
Sugimoto
Hisashi
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000134:cerebrospinal fluid* / Q000494:pharmacology; D001930:Brain Injuries / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000378:metabolism*; D002555:Cerebrospinal Fluid / Q000378:metabolism*; D005260:Female; D006801:Humans; D007249:Inflammation; D007375:Interleukin-1 / Q000097:blood / Q000134:cerebrospinal fluid; D016753:Interleukin-10 / Q000097:blood / Q000134:cerebrospinal fluid; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011379:Prognosis; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis / Q000134:cerebrospinal fluid
D000893:Anti-Inflammatory Agents; D007375:Interleukin-1; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10