Prognostic utility of early plasma matrix metalloproteinases -2 and -9 concentrations after severe traumatic brain injury

Abstract Objective: To determine whether the matrix metalloproteinases-2 and -9 plasma levels were associated with intensive care unit mortality in patients who suffered severe traumatic brain injury, despite the presence of extracerebral injuries. Methods: This prospective cohort enrolled 39 male patients who suffered severe traumatic brain injury (Glasgow coma scale: 3 - 8 at hospital admission). The plasma matrix metalloproteinase -2 and matix metalloproteinase -9 levels were determined by ELISA at the time of intensive care unit admission. Results: Severe traumatic brain injury was associated with a 46% intensive care unit mortality rate. Higher plasma matrix metalloproteinase -9 concentrations were associated with mortality: 147.94 ± 18.00ng/mL for survivors and 224.23 ± 23.86ng/mL for nonsurvivors (mean ± standard error of the mean, p = 0.022). In contrast, there was no significant association between matrix metalloproteinase -2 levels and intensive care unit mortality: 315.68 ± 22.90ng/mL for survivors and 336.55 ± 24.29ng/mL for nonsurvivors (p = 0.499). Additionally, there were no significant associations between matrix metalloproteinase -2 (p = 0.711) and matrix metalloproteinase -9 (p = 0.092) levels and the presence of associated lesions. Conclusion: Increased plasma matrix metalloproteinase -9 levels were associated with intensive care unit mortality following severe traumatic brain injury, regardless of the presence of extracerebral injuries. Conversely, in this same context, plasma matrix metalloproteinase -2 levels were not associated with short-term fatal outcome prediction.摘要 研究目的：明确合并颅脑外损伤的重型颅脑损伤患者中，血浆基质金属蛋白酶-2（matrix metalloproteinase-2）与基质金属蛋白酶-9（matrix metalloproteinase-9）的水平是否与重症监护病房（intensive care unit, ICU）病死率相关。 研究方法：本前瞻性队列研究纳入39例重型颅脑损伤男性患者，其入院时格拉斯哥昏迷量表（Glasgow Coma Scale, GCS）评分为3~8分。于患者入住重症监护病房时，采用酶联免疫吸附试验（Enzyme-Linked Immunosorbent Assay, ELISA）检测其血浆基质金属蛋白酶-2与基质金属蛋白酶-9水平。 研究结果：重型颅脑损伤患者的重症监护病房病死率达46%。血浆基质金属蛋白酶-9水平升高与患者死亡显著相关：存活患者该指标水平为147.94±18.00ng/mL，非存活患者为224.23±23.86ng/mL（均值±标准误，p=0.022）。与之相反，血浆基质金属蛋白酶-2水平与重症监护病房病死率无显著关联：存活患者该指标水平为315.68±22.90ng/mL，非存活患者为336.55±24.29ng/mL（p=0.499）。此外，血浆基质金属蛋白酶-2（p=0.711）与基质金属蛋白酶-9（p=0.092）的水平与合并损伤的存在与否均无显著关联。 研究结论：无论是否合并颅脑外损伤，重型颅脑损伤患者血浆基质金属蛋白酶-9水平升高均与重症监护病房病死率相关。反之，在该研究场景下，血浆基质金属蛋白酶-2水平无法有效预测短期致死结局。