Correlation of Cerebral and Subcutaneous Glycerol in Severe Traumatic Brain Injury and Association with Tissue Damage

Linda Hägglund, Magnus Olivecrona, Lars-Owe D Koskinen, Linda Hägglund, Magnus Olivecrona, Lars-Owe D Koskinen

Abstract

Background: This study is a substudy of a prospective consecutive double-blinded randomized study on the effect of prostacyclin in severe traumatic brain injury (sTBI). The aims of the present study were to investigate whether there was a correlation between brain and subcutaneous glycerol levels and whether the ratio of interstitial glycerol in the brain and subcutaneous tissue (glycerolbrain/sc) was associated with tissue damage in the brain, measured by using the Rotterdam score, S-100B, neuron-specific enolase (NSE), the Injury Severity Score (ISS), the Acute Physiology and Chronic Health Evaluation Score (APACHE II), and trauma type. A potential association with clinical outcome was explored.

Methods: Patients with sTBI aged 15-70 years presenting with a Glasgow Coma Scale Score ≤ 8 were included. Brain and subcutaneous adipose tissue glycerol levels were measured through microdialysis in 48 patients, of whom 42 had complete data for analysis. Brain tissue damage was also evaluated by using the Rotterdam classification of brain computed tomography scans and the biochemical biomarkers S-100B and NSE.

Results: In 60% of the patients, a positive relationship in glycerolbrain/sc was observed. Patients with a positive correlation of glycerolbrain/sc had slightly higher brain glycerol levels compared with the group with a negative correlation. There was no significant association between the computed tomography Rotterdam score and glycerolbrain/sc. S-100B and NSE were associated with the profile of glycerolbrain/sc. Our results cannot be explained by the general severity of the trauma as measured by using the Injury Severity Score or Acute Physiology and Chronic Health Evaluation Score.

Conclusions: We have shown that peripheral glycerol may flux into the brain. This effect is associated with worse brain tissue damage. This flux complicates the interpretation of brain interstitial glycerol levels. We remind the clinicians that a damaged blood-brain barrier, as seen in sTBI, may alter the concentrations of various substances, including glycerol in the brain. Awareness of this is important in the interpretation of the data bedside as well in research.

Trial registration: ClinicalTrials.gov NCT01363583.

Keywords: Brain computed tomography; Glycerol; Microdialysis; Neuron-specific enolase; Outcome; S-100B; Traumatic brain injury.

Conflict of interest statement

The authors declare no conflict of interest.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
A schematic presentation of the inclusion and exclusion of the patients. CPP cerebral perfusion pressure, GCS Glasgow Coma Scale Score
Fig. 2
Fig. 2
Bar plot of the regression plot slope coefficient between brain and subcutaneous glycerol in the total group and groups with a positive or negative correlation. Two-tailed unpaired t-test
Fig. 3
Fig. 3
Bar plot of the levels of the biochemical biomarkers in relation to the regression plot slope coefficient between brain and subcutaneous glycerol in the groups with a positive or negative correlation. Observe that the S-100B values are × 10 for visibility. Two-tailed unpaired t-test. NSEAUC bulk release of neuron-specific enolase, NSEmax maximal level of neuron-specific enolase, S-100BAUC bulk release of S-100B, S-100Bmax maximal level of S-100B

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