Introduction. Traumatic brain injury (TBI) consist one third of all traumas and is a leading cause of mortality and morbidity. The effectiveness of therapeutic measures in TBI depends primarily on the prompt diagnosis. Diagnostics include laboratory blood and urine indicators. Special place is taken by nitrogen oxide (NO) gas transmitter. The peculiarities of the NO in trauma are that it is synthesized very quickly in response to the stimuli, and upon release, enters the cell by diffusion without requiring receptors to initiate intracellular signals, and then chemically modifies the cellular targets. Important role is noted also for deoxyribonucleic acid (DNA) and ribonucleic acid (RNA).
Objectives. To define the significance of NO gas transmitter, RNA and DNA for prognosis at the patients with severe TBI.
Methods. We analyzed the results of the diagnostics data of 72 patients with severe TBI aged 18 to 76 years (mean age 42.3 ± 15.0 years), which were divided into 4 groups according to the Glasgow Outcome scale (GOS): "Death" (1 point on GOS, 36 patients), "Significant disability" (2-3 points on GOS, 8 patients), "Moderate disability" (4 points on GOS, 18 patients), "Recovery" (5 points on GOS, 10 patients). Control group cosisted 22 practically healthy volunteers. The studies included assessing the dynamics and correlation of NO, RNA, and DNA over first 30 days of treatment.
Results. The comparison of NO values in the main groups of outcomes showed that the NO index in the “Death” group was higher than one of all other groups in almost all days (except 14th day) of observation (p<0.05). In patients of “Moderate disability” group, the level of NO was the lowest in almost all groups (p <0.05) from the 7th to the 14th day, as in the “Recovery” group - on the fifth day (p <0.05).
We noted an increase of NO in patients with lethal outcome (direct strong correlation (r = + 0.75, p <0.01)) and decrease during the intensive care in patients with moderate disability and recovery (inverse strong correlation r = -0.77, p <0.01). Overall, in patients with severe TBI, the mean level of nucleic acids tended to decline: the DNA index decreased from 8.60 ± 0.35 μg / ml on the 1st day to 6.65 ± 2.15 μg / ml on the 30th day of treatment ( p> 0.05), the RNA level decreased from 626.82 ± 13.27 to 347.00 ± 151.00 μg / ml (p <0.05). Comparison of these indicators between groups showed that the DNA level in the “Death” group was significantly higher from 9th to 14th days compared to the “Recovery” group, and in all days of the study with the control group (p <0.01); level of RNA was highest on day 14 compared with the “Recovery” group and higher for the whole observation period than in the control group (p <0.01). The highest levels of DNA at day 9 and RNA at day 14 among all other outcome groups of patients were prognosticators of poor outcome for patients in “Death” group. In mostly all days of the study, DNA and RNA levels were the lowest among all outcome groups in the patients who were recovered. Decreases in DNA and RNA levels during treatment were confirmed by strong inverse correlation of DNA and RNA contents during the observation period (r = -0.94, r = -0.93, p <0.01, respectively).
Conclusion: significant changes of biochemical parameters were observed at the patients with severe TBI: high levels of urinary NO metabolites and blood serum nucleic acids (DNA and RNA), that reliably correlated with outcomes. The results of the investigation will be useful for practitioners to assess the patient's condition and choose appropriate treatment approach, which will minimize the secondary brain traumatization and predict the outcomes of TBI.
Full text: PDF (Ukr) 404K