title: Serum caspase-3 levels and mortality are associated in patients with severe traumatic brain injury.
abstract: BACKGROUND
  Different apoptosis pathways activate caspase-3. In a study involving 27 patients with traumatic brain injury (TBI), higher caspase-3 levels were found in contusion brain tissue resected from non-survivors than from survivors. The objective of this study was to determine whether there is an association in TBI patients between serum caspase-3 levels (thus using an easier, quicker, less expensive and less invasive procedure) and mortality, in a larger series of patients.
  
  
  METHODS
  We carried out a prospective, observational and multicenter study in six Spanish Hospital Intensive Care Units including 112 patients with severe TBI. All had Glasgow Coma Scale (GCS) scores lower than 9. Patients with an Injury Severity Score (ISS) in non-cranial aspects higher than 9 were excluded. Blood samples were collected on day 1 of TBI to measure serum caspas-3 levels. The endpoint was 30-day mortality.
  
  
  RESULTS
  We found that non-surviving patients (n = 31) showed higher (p = 0.003) serum caspase-3 levels compared to survivors (n = 81). Kaplan-Meier survival analysis showed a higher risk of death in TBI patients with serum caspase-3 levels >0.20 ng/mL than in patients with lower concentrations (Hazard Ratio = 3.15; 95% CI = 1.40 to 7.08; P < 0.001). Multiple logistic regression analysis showed that serum caspase-3 levels > 0.20 ng/mL were associated with mortality at 30 days in TBI patients controlling for Marshall CT classification, age and GCS (Odds ratio = 7.99; 95% CI = 2.116 to 36.744; P = 0.001).
  
  
  CONCLUSIONS
  The association between serum caspase-3 levels and mortality in TBI patients was the major novel finding of our study.
authors.affiliation: Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n. La Laguna, 38320, Santa Cruz de Tenerife, Spain. 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. mar.martinvelasco@gmail.com.
authors.forename: María M
authors.initials: MM
authors.lastname: Martín
authors.affiliation: Intensive Care Unit, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibáñez n°17-19, Valencia, 46004, Spain. moni_begasa@hotmail.com.
authors.forename: Mónica
authors.initials: M
authors.lastname: Argueso
authors.affiliation: Intensive Care Unit, Hospital General de La Palma, Buenavista de Arriba s/n, Breña Alta, La Palma, 38713, Spain. lramosgomez@gmail.com.
authors.forename: Luis
authors.initials: L
authors.lastname: Ramos
authors.affiliation: Intensive Care Unit, Hospital Universitario Dr. Negrín, CIBERES, Barranco de la Ballena s/n, Las Palmas de Gran Canaria, 35010, Spain. jsolvio@gobiernodecanarias.org.
authors.forename: Jordi
authors.initials: J
authors.lastname: Solé-Violán
authors.affiliation: Servicio de Bioquímica Clínica, Complejo Hospitalario Universitario Insular Materno-Infantil, Plaza Dr. Pasteur s/n, Las Palmas de Gran Canaria, 35016, Spain. mriarui@gobiernodecanarias.org.
authors.forename: Marta
authors.initials: M
authors.lastname: Riaño-Ruiz
authors.affiliation: Research Unit, Hospital Universitario de Canarias, Ofra, s/n. La Laguna, 38320, Santa Cruz de Tenerife, Spain. ajimenezsosa@gmail.com.
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. jmborreguero@hotmail.com.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Borreguero-León
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000097:blood* / Q000150:complications / Q000401:mortality*; D053148:Caspase 3 / Q000097:blood*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012044:Regression Analysis; D017741:Survivors
chemical_list: C505407:CASP3 protein, human; D053148:Caspase 3