| Abstract |
Background
According to WHO, Traumatic Brain Injury (TBI) has been the leading cause of death and
disability in recent years. TBI is a very important public and personal health issue. Patients
with TBI are classified into three categories based on the severity of the injury (mild,
moderate, severe). To date, no reliable biomarker is used in daily clinical practice for TBI.
Cytokines play an important role in the immune response, systemic inflammation and the
coagulation system. Some of them play an important role in initiating and maintaining the
inflammatory process, while others in stopping it. The most studied ones, according to the
literature, are Interleukin-1, Interleukin-6 (IL-6), Interleukin-8, Interleukin-10 (IL-10) and
Tumor Necrosis Factor Alpha (TNF-α).
Objective
The objective of the present study is to investigate the hypothesis that immune mechanisms
play a major role in the pathophysiology and clinical concequences of TBI. Two cytokines
with an important role in inflammatory responses are IL-6 and IL-10. The first is considered
pro-inflammatory cytokine, while the second is anti-inflammatory. The research hypothesis is
that elevated plasma IL-6 and/or IL-10 levels are statistically significantly related to the
diagnosis and prognosis of TBI patients.
Methods
This is a clinical study. The sample size consisted of 39 patients with TBI, who have been
treated at the Neurosurgery Department, the Adult Intensive Care Unit and the Pediatric
Intensive Care Unit of University Hospital of Heraklion. IL-6 and IL-10 were measured in
the blood samples of the patients on the 1st and 7th post-traumatic days, by Enzyme-Linked
Immunosorbent Assay (ELISA). In addition, multiple variables ( epidemiological, clinical,
laboratory, imaging) were recorded that could be related to the prognosis or diagnosis of
these patients.
Results
The increased values of IL-6 and IL-10 on the first post-traumatic day appeared to be
associated with a reduced score on all outcome scales: 7-day Glasgow Outcome Scale (GOS), 7-day Glascow Coma Scale (GCS), 7-day Karnofsky Performance Scale (KPS) (in all cases
p-value <0.005). The increased value of 7-day IL-10 appeared to be associated with a reduced
score on all outcome scales: 7-day GOS, 7-day GCS, 7-day KPS (in all cases p-value
<0.005). In predicting an unfavourable outcome, the area under the curve (ROC) for IL-6 was
0.722 (95% CI: 0.55-0.89; p= 0.021) and for IL-10 0.733 (95% CI: 0.55-0.92; p= 0.015).
Among the CT scoring systems, the Rotterdam CT score displayed the highest performance
(AUC 0.825, 95% CI: 0.69-0.96; p= 0.001).
Conclusion
The present study has strengthened the data on the important role of pro-inflammatory IL-6
and anti-inflammatory IL-10 in the TBI entity. Specifically, the increased values of both IL-6
and IL-10 in the first 24 hours post-traumatically appeared to be related to the severity of the
diagnosis and outcome 7 days after TBI.
Based on the above, the main conclusion is that both interleukins studied could be used as
diagnostic and prognostic biomarkers for TBI.
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