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Serial serum leukocyte apoptosis levels as predictors of outcome in acute traumatic brain injury.

Wang HC, Yang TM, Lin YJ, Chen WF, Ho JT, Lin YT, Kwan AL, Lu CH - Biomed Res Int (2014)

Bottom Line: Brief unconsciousness (P = 0.009), motor deficits (P ≤ 0.001), GCS (P ≤ 0.001), ISS (P = 0.001), WBC count (P = 0.015), late apoptosis in lymphocytes and monocytes on Day 1 (P = 0.004 and P = 0.022, resp.), subdural hemorrhage on initial brain CT (P = 0.002), neurosurgical intervention (P ≤ 0.001), and acute posttraumatic seizure (P = 0.046) were significant risk factors of outcome.Only motor deficits (P = 0.033) and late apoptosis in monocytes on Day 1 (P = 0.037) were independently associated with outcome.A cutoff value of 5.72% of late apoptosis in monocytes was associated with poor outcome in acute TBI patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan ; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.

ABSTRACT

Background: Apoptosis associates with secondary brain injury after traumatic brain injury (TBI). This study posits that serum leukocyte apoptosis levels in acute TBI are predictive of outcome.

Methods: Two hundred and twenty-nine blood samples from 88 patients after acute TBI were obtained on admission and on Days 4 and 7. Serial apoptosis levels of different leukocyte subsets were examined in 88 TBI patients and 27 control subjects.

Results: The leukocyte apoptosis was significantly higher in TBI patients than in controls. Brief unconsciousness (P = 0.009), motor deficits (P ≤ 0.001), GCS (P ≤ 0.001), ISS (P = 0.001), WBC count (P = 0.015), late apoptosis in lymphocytes and monocytes on Day 1 (P = 0.004 and P = 0.022, resp.), subdural hemorrhage on initial brain CT (P = 0.002), neurosurgical intervention (P ≤ 0.001), and acute posttraumatic seizure (P = 0.046) were significant risk factors of outcome. Only motor deficits (P = 0.033) and late apoptosis in monocytes on Day 1 (P = 0.037) were independently associated with outcome. A cutoff value of 5.72% of late apoptosis in monocytes was associated with poor outcome in acute TBI patients.

Conclusion: There are varying degrees of apoptosis in patients following TBI and in healthy individuals. Such differential expression suggests that apoptosis in different leukocyte subsets plays an important role in outcome following injury.

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Related in: MedlinePlus

Mean percentages of early apoptosis (annexin V) in (a) total leukocytes, (b) neutrophils, (c) lymphocytes, and (d) monocytes on Days 1, 4, and 7 in patients with acute TBI and in the controls. AP < 0.05, acute TBI patients with good outcome versus health controls; BP < 0.05, acute TBI patients with poor outcome versus health controls; *P < 0.05, acute TBI patients with poor outcome versus those with good outcome, by Mann-Whitney U test.
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fig1: Mean percentages of early apoptosis (annexin V) in (a) total leukocytes, (b) neutrophils, (c) lymphocytes, and (d) monocytes on Days 1, 4, and 7 in patients with acute TBI and in the controls. AP < 0.05, acute TBI patients with good outcome versus health controls; BP < 0.05, acute TBI patients with poor outcome versus health controls; *P < 0.05, acute TBI patients with poor outcome versus those with good outcome, by Mann-Whitney U test.

Mentions: The time course of leukocyte apoptotic changes in acute TBI patients with good and poor outcomes, as determined by GOS, was compared. The percentages of apoptosis of annexin V+7-AAD in lymphocytes and in monocytes were significantly lower in the good outcome group (median: 1.44 and 4.79, resp.) than in the poor outcome group (median: 4.81 and 11.94, resp.) on Day 1. There was statistically significant difference (P = 0.004 and P = 0.022, resp.) (Figures 3(c) and 3(d)). There was no other statistically significant difference between the two outcome groups in the percentages of apoptosis of total leukocytes and their subsets from Day 1 to Day 7 (Figures 1–3).


Serial serum leukocyte apoptosis levels as predictors of outcome in acute traumatic brain injury.

Wang HC, Yang TM, Lin YJ, Chen WF, Ho JT, Lin YT, Kwan AL, Lu CH - Biomed Res Int (2014)

Mean percentages of early apoptosis (annexin V) in (a) total leukocytes, (b) neutrophils, (c) lymphocytes, and (d) monocytes on Days 1, 4, and 7 in patients with acute TBI and in the controls. AP < 0.05, acute TBI patients with good outcome versus health controls; BP < 0.05, acute TBI patients with poor outcome versus health controls; *P < 0.05, acute TBI patients with poor outcome versus those with good outcome, by Mann-Whitney U test.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4016848&req=5

fig1: Mean percentages of early apoptosis (annexin V) in (a) total leukocytes, (b) neutrophils, (c) lymphocytes, and (d) monocytes on Days 1, 4, and 7 in patients with acute TBI and in the controls. AP < 0.05, acute TBI patients with good outcome versus health controls; BP < 0.05, acute TBI patients with poor outcome versus health controls; *P < 0.05, acute TBI patients with poor outcome versus those with good outcome, by Mann-Whitney U test.
Mentions: The time course of leukocyte apoptotic changes in acute TBI patients with good and poor outcomes, as determined by GOS, was compared. The percentages of apoptosis of annexin V+7-AAD in lymphocytes and in monocytes were significantly lower in the good outcome group (median: 1.44 and 4.79, resp.) than in the poor outcome group (median: 4.81 and 11.94, resp.) on Day 1. There was statistically significant difference (P = 0.004 and P = 0.022, resp.) (Figures 3(c) and 3(d)). There was no other statistically significant difference between the two outcome groups in the percentages of apoptosis of total leukocytes and their subsets from Day 1 to Day 7 (Figures 1–3).

Bottom Line: Brief unconsciousness (P = 0.009), motor deficits (P ≤ 0.001), GCS (P ≤ 0.001), ISS (P = 0.001), WBC count (P = 0.015), late apoptosis in lymphocytes and monocytes on Day 1 (P = 0.004 and P = 0.022, resp.), subdural hemorrhage on initial brain CT (P = 0.002), neurosurgical intervention (P ≤ 0.001), and acute posttraumatic seizure (P = 0.046) were significant risk factors of outcome.Only motor deficits (P = 0.033) and late apoptosis in monocytes on Day 1 (P = 0.037) were independently associated with outcome.A cutoff value of 5.72% of late apoptosis in monocytes was associated with poor outcome in acute TBI patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan ; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.

ABSTRACT

Background: Apoptosis associates with secondary brain injury after traumatic brain injury (TBI). This study posits that serum leukocyte apoptosis levels in acute TBI are predictive of outcome.

Methods: Two hundred and twenty-nine blood samples from 88 patients after acute TBI were obtained on admission and on Days 4 and 7. Serial apoptosis levels of different leukocyte subsets were examined in 88 TBI patients and 27 control subjects.

Results: The leukocyte apoptosis was significantly higher in TBI patients than in controls. Brief unconsciousness (P = 0.009), motor deficits (P ≤ 0.001), GCS (P ≤ 0.001), ISS (P = 0.001), WBC count (P = 0.015), late apoptosis in lymphocytes and monocytes on Day 1 (P = 0.004 and P = 0.022, resp.), subdural hemorrhage on initial brain CT (P = 0.002), neurosurgical intervention (P ≤ 0.001), and acute posttraumatic seizure (P = 0.046) were significant risk factors of outcome. Only motor deficits (P = 0.033) and late apoptosis in monocytes on Day 1 (P = 0.037) were independently associated with outcome. A cutoff value of 5.72% of late apoptosis in monocytes was associated with poor outcome in acute TBI patients.

Conclusion: There are varying degrees of apoptosis in patients following TBI and in healthy individuals. Such differential expression suggests that apoptosis in different leukocyte subsets plays an important role in outcome following injury.

Show MeSH
Related in: MedlinePlus