Journal article
Cerebrospinal Fluid Markers of Macrophage and Lymphocyte Activation after Traumatic Brain Injury in Children
Pediatric critical care medicine, Vol.16(6), pp.549-557
07/2015
DOI: 10.1097/PCC.0000000000000400
PMCID: PMC4497935
PMID: 25850867
Abstract
Objectives: The magnitude and role of the cellular immune response following pediatric traumatic brain injury remains unknown. We tested the hypothesis that macrophage/microglia and T-cell activation occurs following pediatric traumatic brain injury by measuring cerebrospinal fluid levels of soluble cluster of differentiation 163 and ferritin and soluble interleukin-2 receptor α, respectively, and determined whether these biomarkers were associated with relevant clinical variables and outcome.
Design: Retrospective analysis of samples from an established, single-center cerebrospinal fluid bank.
Setting: PICU in a tertiary children's hospital.
Patients: Sixty-six pediatric patients after severe traumatic brain injury (Glasgow Coma Scale score < 8) who were 1 month to 16 years old and 17 control patients who were 1 month to 14 years old.
Interventions: None.
Measurements and main results: Cerebrospinal fluid levels of soluble cluster of differentiation 163, ferritin, and soluble interleukin-2 receptor α were determined by enzyme-linked immunosorbent assay at two time points (t1 = 17 ± 10 hr; t2 = 72 ± 15 hr) for each traumatic brain injury patient. Cerebrospinal fluid levels of soluble cluster of differentiation 163, ferritin, and soluble interleukin-2 receptor α after traumatic brain injury were compared with controls and analyzed for associations with age, patient sex, initial Glasgow Coma Scale score, diagnosis of abusive head trauma, the presence of hemorrhage on CT scan, and Glasgow Outcome Scale score. Cerebrospinal fluid level of soluble cluster of differentiation 163 was increased in traumatic brain injury patients at t2 versus t1 and controls (median, 95.4 ng/mL [interquartile range, 21.8-134.0 ng/mL] vs 31.0 ng/mL [5.7-77.7 ng/mL] and 27.8 ng/mL [19.1-43.1 ng/mL], respectively; p < 0.05). Cerebrospinal fluid level of ferritin was increased in traumatic brain injury patients at t2 and t1 versus controls (8.3 ng/mL [<7.5-19.8 ng/mL] and 8.9 ng/mL [<7.5-26.7 ng/mL] vs <7.5 ng/mL below lower limit of detection, respectively; p < 0.05). Cerebrospinal fluid levels of soluble interleukin-2 receptor α in traumatic brain injury patients at t2 and t1 were not different versus controls. Multivariate regression revealed associations between high ferritin and age 4 years or younger, lower Glasgow Coma Scale score, abusive head trauma, and unfavorable Glasgow Outcome Scale score.
Conclusions: Children with traumatic brain injury demonstrate evidence for macrophage activation after traumatic brain injury, and in terms of cerebrospinal fluid ferritin, this appears more prominent with young age, initial injury severity, abusive head trauma, and unfavorable outcome. Further study is needed to determine whether biomarkers of macrophage activation may be used to discriminate between aberrant and adaptive immune responses and whether inflammation represents a therapeutic target after traumatic brain injury.
Details
- Title: Subtitle
- Cerebrospinal Fluid Markers of Macrophage and Lymphocyte Activation after Traumatic Brain Injury in Children
- Creators
- Elizabeth Newell - Department of Pediatrics, University of IowaDavid K Shellington - Department of Pediatrics, University of California San DiegoDennis W Simon - Department of Critical Care Medicine, University of Pittsburgh School of MedicineMichael J Bell - Department of Critical Care Medicine, University of Pittsburgh School of MedicinePatrick M Kochanek - Department of Critical Care Medicine, University of Pittsburgh School of MedicineKeri Feldman - Department of Critical Care Medicine, University of Pittsburgh School of MedicineHülya Bayır - Department of Critical Care Medicine, University of Pittsburgh School of MedicineRajesh K Aneja - Department of Critical Care Medicine, University of Pittsburgh School of MedicineJoseph A Carcillo - Department of Critical Care Medicine, University of Pittsburgh School of MedicineRobert S. B Clark - Department of Critical Care Medicine, University of Pittsburgh School of Medicine
- Resource Type
- Journal article
- Publication Details
- Pediatric critical care medicine, Vol.16(6), pp.549-557
- DOI
- 10.1097/PCC.0000000000000400
- PMID
- 25850867
- PMCID
- PMC4497935
- NLM abbreviation
- Pediatr Crit Care Med
- ISSN
- 1529-7535
- eISSN
- 1947-3893
- Language
- English
- Date published
- 07/2015
- Academic Unit
- Critical Care; Stead Family Department of Pediatrics; Iowa Neuroscience Institute
- Record Identifier
- 9984065825802771
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