In the current study the investigators intend to evaluate the role of Ischemia modified albumin (IMA) in the prediction of poor outcome in patients with traumatic brain injury (TBI). The investigators hypothesize that IMA will be elevated in patients with traumatic brain injury due to the excessive production of reactive oxygen species by the injured brain.
Consecutive adult patients who were admitted with TBI, blood samples were taken once written informed consent obtained. Initial evaluation on admission was performed simultaneously by ICU physician and a neurosurgical resident by means of a detailed physical and neurological examination. Demographic characteristics and vascular risk factors (hypertension, diabetes mellitus, hyperlipidemia, and peripheral ischemic disease) were recorded in details. Also, Routine blood tests, including full blood count, coagulation tests, glucose level, renal and hepatic function tests, total protein, and albumin levels; chest radiography were done. CT scan will be performed in all the cases for the confirmation of TBI. Glasgow coma scale (GCS) was assessed on admission and recorded and assessed daily to evaluate prognosis. Patients were monitored by BP, ECG, and Pulse oximetry. All patients received standard medical treatment which included anti-edema measures mannitol 20%, 0.25-0.5 g/kg over 20 min, (not exceeding a total of 2 g/kg of body weight in 24 h) in patients with symptoms of raised intracranial pressure, and other supportive therapy for the treatment of concurrent illnesses such as hypertension and diabetes mellitus. Biochemical Assessments: Blood samples from TBI patients were collected immediately at the time of admission to the ICU and 24 hours later. Samples were centrifuged at 2500 RPM for 15 minutes and obtained serum samples were stored at -20oC. IMA was measured by the colorimetric method and results were presented in absorbance units (ABSU). Data collection * Patients' characteristics: age, gender, BMI, cause of ICU admission. * IMA will be measured at time of admission to ICU and 24h later * Other data collections: * Hear rate (HR), systolic blood pressure,central venous pressure (CVP), body temperature. All hemodynamic parameters were measured and recorded at time of admission and every 2 hours for 24 hours * Length of ICU stay * 28-day mortality * Troponin I level on admission. * GCS at admission and daily till mortality or discharge
Study Type
OBSERVATIONAL
Enrollment
54
Ischemia modified albumin is a biomarker for cardiac ischemia and acute stroke whether ischemic or hemorrhagic
Kasr El Aini Hospital
Cairo, Egypt
Correlation between IMA and mortality following TBI
IMA in ng/ml will be measured at time of admission to ICU and correlated with 28 day mortality
Time frame: The number of patients who died within 28 days from admission to ICU after TBI and who were investigated for IMA upon admission to ICU
Correlation between 24 hours IMA and mortality following TBI
IMA in ng/ml will be measured 24 hours after admission to ICU and correlated with 28 day mortality
Time frame: The number of patients who died within 28 days from admission to ICU after TBI and who were investigated for IMA 24 hours after admission to ICU
The incidence of patients with elevated IMA
The percentage of patients having elevated IMA in ng/ml from the recruited patients with traumatic brain injuries.
Time frame: IMA on admission to ICU and after 24 hours
The degree of correlation between severity of TBI and IMA
The severity of traumatic brain injury classified by Glasgow Coma Scale as mild 13-15, moderate 9-12 or severe 3-8 and the IMA levels in ng/ml in those patients.
Time frame: Glasgow coma scale immediately on admission to the ICU, IMA will be collected on admission to ICU and after 24 hours
The degree of correlation between mild TBI and ICU length of stay
The number of days spent in ICU for patients with mild TBI (GCS 13-15)
Time frame: The number of days in ICU till discharge or mortality up to 28 days post admission
The degree of correlation between moderate TBI and ICU length of stay
The number of days spent in ICU for patients with moderate TBI (GCS 9-12)
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Time frame: The number of days in ICU till discharge or mortality up to 28 days post admission
The degree of correlation between severe TBI and ICU length of stay
The number of days spent in ICU for patients with severe TBI (GCS 3- 8)
Time frame: The number of days in ICU till discharge or mortality up to 28 days post admission
The degree of correlation between severity of TBI and and deterioration of conscious level
The severity of traumatic brain injury classified by Glasgow Coma Scale as mild 13-15, moderate 9-12 or severe 3-8 on admission and the Glasgow coma scale on the following days in the ICU til mortality or discharge
Time frame: Glasgow coma scale immediately on admission to the ICU and daily till mortality or discharge up to 28 days post admission