Generation of procoagulant microparticles in cerebrospinal fluid and peripheral blood after traumatic brain injury.
BACKGROUND
Traumatic brain injury (TBI) can induce cell damage. Procoagulant microparticles (MPs) are reliable markers of cell stimulation. The aim of this study was to investigate the generation of procoagulant MPs in the cerebrospinal fluid (CSF) and plasma of patients with severe TBI.


METHODS
CSF and plasma MPs of 16 patients with severe TBI were quantified by functional prothrombinase assay (i) on the day of the trauma, (ii) during a 10-day follow-up and compared with control samples. The cellular origin of MP was determined after capture with specific antibodies.


RESULTS
The CSF and plasma of patients with severe TBI revealed a significantly increased generation of MP compared with control samples on the day of the trauma (CSF: 4.5 +/- 1.8 vs. 0.83 +/- 0.28 nanomolar PhtdSer equivalent; p = 0.01 and plasma 4.1 +/- 3.7 vs. 2.3 +/- 0.19 nanomolar PhtdSer equivalent; p = 0.02). Procoagulant MPs were mainly of platelet and endothelial origin in CSF. MPs decreased significantly in the CSF 10 days after TBI. In CSF, a sustained generation of procoagulant MP was evidenced in two patients presenting a poor clinical outcome. In the blood flow, elevated amounts of procoagulant MPs were detected in three patients presenting disseminated intravascular coagulopathy during the follow-up.


CONCLUSIONS
Procoagulant MP testifying to platelet and endothelial activation are produced in the CSF and in the plasma after severe TBI. A sustained generation of procoagulant MP in the CSF could contribute to a poor clinical outcome.
Morel
Nicolas
N
Service de réanimation des urgences, Département des urgences, Hôpital Pellegrin, Place Raba Léon 33000 Bordeaux, France. nicolas.morel@chu-bordeaux.fr
Morel
Olivier
O
Petit
Laurent
L
Hugel
Bénédicte
B
Cochard
Jean-François
JF
Freyssinet
Jean-Marie
JM
Sztark
François
F
Dabadie
Philippe
P
D000328:Adult; D015415:Biomarkers / Q000097:blood / Q000134:cerebrospinal fluid; D001779:Blood Coagulation Factors / Q000378:metabolism*; D001930:Brain Injuries / Q000097:blood* / Q000134:cerebrospinal fluid*; D016022:Case-Control Studies; D004730:Endothelium, Vascular / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D010316:Particle Size; D018709:Statistics, Nonparametric
D015415:Biomarkers; D001779:Blood Coagulation Factors