Plasma Biomarkers of Brain Injury as Diagnostic Tools and Outcome Predictors After Extracorporeal Membrane Oxygenation*

Bembea, Melania M.; Rizkalla, Nicole; Freedy, James; Barasch, Noah; Vaidya, Dhananjay; Pronovost, Peter J.; Everett, Allen D.; Mueller, Gregory P.

doi:10.1097/ccm.0000000000001145

Cited by 56 publications

(37 citation statements)

References 57 publications

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“…Predicting outcome by GCS, ISS, or AIS-head score was less successful and pairing i cORP values with severity scores did not improve their prognostic power. Relative to other published studies, i cORP compares favorably with serum-based Tau, suPAR, and Tau; however measuring ORP has the advantage of providing results more quickly [4, 11, 13, 40–45]. …”

Section: Discussionmentioning

confidence: 93%

Oxidation‐Reduction Potential as a Biomarker for Severity and Acute Outcome in Traumatic Brain Injury

Bjugstad

Rael

Levy

et al. 2016

Oxidative Medicine and Cellular Longevity

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There are few reliable markers for assessing traumatic brain injury (TBI). Elevated levels of oxidative stress have been observed in TBI patients. We hypothesized that oxidation-reduction potential (ORP) could be a potent biomarker in TBI. Two types of ORP were measured in patient plasma samples: the static state of oxidative stress (sORP) and capacity for induced oxidative stress (icORP). Differences in ORP values as a function of time after injury, severity, and hospital discharge were compared using ANOVAs with significance at p ≤ 0.05. Logit regression analyses were used to predict acute outcome comparing ORP, Injury Severity Score (ISS), Abbreviated Injury Scale (AIS), and Glasgow Coma Scale (GCS). Antioxidant capacity (icORP) on day 4 was prognostic for acute outcomes (p < 0.05). An odds ratio of 4.08 was associated with poor acute outcome when icORP > 7.25 μC. IcORP was a better predictor than ISS, AIS, or GCS scores. sORP increased in those with the highest ISS values (p < 0.05). Based on these findings ORP is useful biomarker for severity and acute outcome in TBI patients. Changes in ORP values on day 4 after injury were the most prognostic, suggesting that patients' response to brain injury over time is a factor that determines outcome.

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Section: Discussionmentioning

confidence: 93%

Oxidation‐Reduction Potential as a Biomarker for Severity and Acute Outcome in Traumatic Brain Injury

Bjugstad

Rael

Levy

et al. 2016

Oxidative Medicine and Cellular Longevity

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“…Thus far, none of the abovementioned biomarkers have been shown to have sufficient sensitivity and specificity as predictors of neurological dysfunction after cardiac surgery to be able to serve as a gold standard. Many investigators advocate the analysis of a combination of two or more plasma biomarkers, to get a realistic insight into current and future neurological status, by combining information and thus increasing sensitivity . The aim of the current study was to determine whether classical neuronal damage‐specific biomarkers and PfHb, as a measure of haemolysis, could be used to predict the risk of long‐term POCD after coronary artery bypass surgery, in relation to commonly described risk factors.…”

Section: Introductionmentioning

confidence: 99%

Neuronal damage biomarkers in the identification of patients at risk of long-term postoperative cognitive dysfunction after cardiac surgery

et al. 2016

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Biomarkers of neurological injury can potentially predict postoperative cognitive dysfunction. We aimed to identify whether classical neuronal damage-specific biomarkers, including brain fatty acid-binding protein, neuron-specific enolase and S100 calcium-binding protein β, as well as plasma-free haemoglobin concentration as a measure of haemolysis, could be used to predict the risk of long-term cognitive decline after coronary artery bypass grafting with or without cardiopulmonary bypass. We assessed cognitive function using the CogState brief computerised cognitive test battery at 3 months and at 15 months after surgery. Blood samples were obtained pre-operatively, after sternal closure, and at 6 h and 24 h postoperatively. We found signs of cognitive decline at 3 months in 15 of 57 patients (26%), and in 13 of 48 patients (27%) at 15 months. Brain fatty acid-binding protein was already significantly higher before surgery in patients with postoperative cognitive dysfunction at 15 months, with pre-operative plasma levels of 22.8 (8.3-33.0 [0-44.6]) pg.ml compared with 9.7 (3.9-17.3 [0-49.0]) pg.ml in patients without cognitive dysfunction. This biomarker remained significantly higher in patients with cognitive decline throughout the entire postoperative period. At 3 months after surgery, high levels of plasma-free haemoglobin at sternal closure were associated with a negative influence on cognitive performance, as were high baseline scores on neuropsychological tests, whereas a higher level of education proved to beneficially influence cognitive outcome. We found that postoperative cognitive dysfunction at 3 months was associated with cognitive decline at 15 months after surgery, and served as a valuable prognostic factor for declines in individual cognitive performance one year later. Classical neuronal injury-related biomarkers were of no clear prognostic value.

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“…Several plasma proteins have been evaluated as potential markers for brain injury [63]. These biomarkers include substances associated with glial injury (glial fibrillary acidic protein and s-100b), neuronal injury (neuron-specific enolase and brain-derived neurotrophic factor) and neuro-inflammation (intercellular adhesion molecue-5).…”

Section: Biomarkersmentioning

confidence: 99%

Neurologic Complications and Neuromonitoring on ECMO

Pinto¹

2019

Advances in Extracorporeal Membrane Oxygenation - Volume 3

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Extracorporeal membrane oxygenation is challenged by several potential complications. Adverse neurologic events such as intracranial hemorrhages, strokes, seizures, and brain death are among the most detrimental and even catastrophic of ECMO complications. There are several risk factors related to the patients, their underlying conditions and the therapy itself that predispose these patients to neurologic injuries. In this chapter, we review different types of neurological complications, the identification and management of which can be difficult. We will also discuss some of the currently available technologies for multimodal neurological monitoring as a complement to clinical exam.

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Plasma Biomarkers of Brain Injury as Diagnostic Tools and Outcome Predictors After Extracorporeal Membrane Oxygenation*

Cited by 56 publications

References 57 publications

Oxidation‐Reduction Potential as a Biomarker for Severity and Acute Outcome in Traumatic Brain Injury

Oxidation‐Reduction Potential as a Biomarker for Severity and Acute Outcome in Traumatic Brain Injury

Neuronal damage biomarkers in the identification of patients at risk of long-term postoperative cognitive dysfunction after cardiac surgery

Neurologic Complications and Neuromonitoring on ECMO

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