title: Serum soluble CD40 Ligand levels are associated with severity and mortality of brain trauma injury patients.
abstract: BACKGROUND
  Serum soluble CD40 Ligand (sCD40L) levels, which exhibit prothrombotic and proinflammatory properties, have not been studied in patients with traumatic brain injury (TBI). Thus, the objective of this study was to determine whether serum sCD40L levels are associated with severity and mortality in patients with severe TBI.
  
  
  METHODS
  This was a prospective, observational and multicenter study carried out in six Spanish Intensive Care Units. Patients with severe TBI defined as Glasgow Coma Scale (GCS) lower than 9 were included, while those with Injury Severity Score (ISS) in non-cranial aspects higher than 9 were excluded. Serum levels of sCD40L were measured on the day of TBI. Endpoint was established in 30-day mortality.
  
  
  RESULTS
  We found higher serum sCD40L levels (P<0.001) in non-surviving TBI patients (N=27) than in survivor ones (N=73). Logistic regression analysis showed that serum sCD40L levels were associated with 30-day mortality (OR=1.58; 95% CI=1.12-2.21; P=0.008) controlling for APACHE-II score and computer tomography findings. The area under the curve (AUC) for serum sCD40L levels as predictor of 30-day mortality was 0.79 (95% CI=0.70-0.86; P<0.001). Survival analysis showed that patients with serum sCD40L levels higher than 2.11 ng/mL presented increased 30-day mortality than patients with lower levels (Hazard ratio=9.0; 95% CI=4.25-19.27; P<0.001). We found an association between serum sCD40L levels and APACHE-II (rho=0.33; P=0.001), and GCS score (rho=-0.21; P=0.04).
  
  
  CONCLUSIONS
  To our knowledge, this is the first study reporting data on serum sCD40L levels in patients with severe TBI. The most relevant and newer findings of our study are that serum sCD40L levels in non-surviving patients with severe TBI are higher than in surviving ones, and that there are an association between serum sCD40L levels and TBI severity and mortality.
authors.affiliation: Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n. La Laguna - 38320, Santa Cruz de Tenerife, Spain. Electronic address: lorentemartin@msn.com.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Lorente
authors.affiliation: Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Crta del Rosario s/n. Santa Cruz de Tenerife - 38010, Spain.
authors.forename: María M
authors.initials: MM
authors.lastname: Martín
authors.affiliation: Laboratory Deparment, Hospital Universitario de Canarias, Ofra, s/n. La Laguna - 38320, Santa Cruz de Tenerife, Spain.
authors.forename: Agustín F
authors.initials: AF
authors.lastname: González-Rivero
authors.affiliation: Intensive Care Unit, Hospital General La Palma, Buenavista de Arriba s/n, Breña Alta, La Palma- 38713, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Ramos
authors.affiliation: Intensive Care Unit, Hospital Clínico Universitario de Valencia, Avda, Blasco Ibáñez n°17-19, Valencia - 46004, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Argueso
authors.affiliation: Intensive Care Unit, Hospital Insular, Plaza Dr. Pasteur s/n. Las Palmas de Gran Canaria - 35016, Spain.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Cáceres
authors.affiliation: Intensive Care Unit, Hospital Universitario Dr. Negrín, Barranco de la Ballena s/n. Las Palmas de Gran Canaria - 35010, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Solé-Violán
authors.affiliation: Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n. La Laguna - 38320, Santa Cruz de Tenerife, Spain.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Serrano
authors.affiliation: Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Crta del Rosario s/n. Santa Cruz de Tenerife - 38010, Spain.
authors.forename: Sergio T
authors.initials: ST
authors.lastname: Rodríguez
authors.affiliation: Research Unit, Hospital Universitario de Canarias, Ofra, s/n. La Laguna - 38320, Santa Cruz de Tenerife, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Jiménez
authors.affiliation: Laboratory Deparment, Hospital Universitario de Canarias, Ofra, s/n. La Laguna - 38320, Santa Cruz de Tenerife, Spain.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Borreguero-León
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology*; D001930:Brain Injuries / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D023201:CD40 Ligand / Q000097:blood*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis
chemical_list: D023201:CD40 Ligand
keywords: Brain trauma; Injury; Mortality; Patients; sCD40L