Apoptosis of neuronal cells induced by serum of patients with acute brain injury: a new in vitro prognostic model.
OBJECTIVE
To investigate whether serum draining from the jugular bulb of patients with traumatic or haemorrhagic brain injury induced apoptosis of neuronal PC12 cells in vitro and whether the apoptotic rate correlated with patients' outcome at 6 months.


METHODS
Prospective clinical investigation in a 21-bed intensive care unit (ICU) in a university hospital.


METHODS
Seventy patients who had suffered from acute brain injury requiring intensive care.


METHODS
Jugular bulb vein and systemic samples were obtained on admission to the ICU and after 48 h. PC12 cells were incubated in the presence of 10% of heat-inactivated patient's sera and apoptotic rate was determined by flow cytometry using annexin V and 7-aminoactinomycin D.


RESULTS
Regional serum draining from the lesions induced higher early apoptosis of PC12 cells than systemic serum. Early apoptotic rate, Glasgow coma score, APACHE II score and the presence of pupil abnormalities were associated with mortality at 6 months in univariate statistical analyses. In logistic regression analysis only early apoptotic rate was an independent factor associated with mortality at 6 months (odds ratio: 1.502, 95% CI 1.2-1.9; p<0.001). The final model has a sensitivity of 82.4% and a specificity of 84.8% for predicting death within 6 months.


CONCLUSIONS
We developed a simple and reproducible in vitro model for predicting outcome in patients with traumatic or haemorrhagic brain injury that survived in the early phase. Our in vitro model combined with clinical and radiological measurements might improve the value of prognostic models to predict acute brain injury patients' outcome.
Ballesteros
Maria Angeles
MA
Departamento de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Avda Valdecilla s/n, 39008, Santander, Spain.
López-Hoyos
Marcos
M
Muñoz
Pedro
P
Marin
Maria Jose
MJ
Miñambres
Eduardo
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D017209:Apoptosis; D001790:Blood Physiological Phenomena; D001930:Brain Injuries / Q000473:pathology*; D002478:Cells, Cultured; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009474:Neurons / Q000473:pathology*; D011379:Prognosis