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Systems Analysis of the Neuroinflammatory and Hemodynamic Response to Traumatic Brain Injury
Published on: May 27, 2022
Brain interstitial glycerol correlates with evolving brain injury in paediatric traumatic brain injury
Nqobile S Thango1, Ursula K Rohlwink1,2, Lindizwe Dlamini1
1Division of Neurosurgery, Department of Surgery, University of Cape Town, Cape Town, South Africa.
Insights
Brain glycerol monitoring in children with traumatic brain injury (TBI) shows increased lesion size. This cerebral microdialysis (CMD) marker may help track evolving injury in pediatric TBI patients.
Area of Science:
- Neuroscience
- Pediatric Critical Care
- Biomarker Research
Background:
- Traumatic brain injury (TBI) pathophysiology requires better therapeutic targets.
- Cerebral microdialysis (CMD) offers advanced brain monitoring, but pediatric data is limited.
- Brain glycerol, a CMD variable, is a potential marker for tissue hypoxia in adults.
Purpose of the Study:
- To investigate the time course and associations of brain glycerol in pediatric TBI.
- To evaluate glycerol as a potential biomarker in children with TBI.
Main Methods:
- Retrospective cohort study of children (<13 years) with severe TBI undergoing CMD.
- Examined glycerol's relationship with physiological, radiological variables, and clinical outcomes.
- Utilized head CT to assess lesion progression and size.
Main Results:
- Twenty-eight children had evaluable CMD data.
- Increased lesion size (>30%) on CT correlated strongly with glycerol levels (p=0.01-0.004).
- Absolute glycerol showed weak associations with intracranial pressure and brain oxygenation; no clinical outcome link found.
Conclusions:
- This is the first study on brain interstitial glycerol in pediatric TBI.
- Elevated CMD glycerol, especially increases from baseline, correlates with injury markers and lesion expansion.
- CMD glycerol may serve as a valuable monitor for evolving injury in pediatric TBI.
Purpose:
A better understanding of the complex pathophysiology of traumatic brain injury (TBI) is needed to improve our current therapies. Cerebral microdialysis (CMD) is an advanced method to monitor the brain, but little is known about its parameters in children. Brain glycerol, one of the CMD variables, is an essential component of the phospholipid bilayer cell membrane and is considered a useful marker of tissue hypoxia in adults. This study examined the time course of glycerol and its associations in paediatric TBI.
Methods:
In this retrospective cohort study, we collected data on children (< 13years) with severe TBI who underwent CMD monitoring. The relationship of glycerol was examined with respect to physiological, radiological variables, and clinical outcome.
Results:
Twenty-eight children underwent CMD monitoring and had evaluable data. Lesion progression on head computed tomography (CT) demonstrated a strong relationship with glycerol (median glycerol, maximum and initial-to-maximum) when lesion size increased by > 30% (p=0.01, p=0.04 and p=0.004). Absolute glycerol values had a weak but statistically significant association with intracranial pressure and brain oxygenation. We did not find an association with clinical outcome.
Conclusion:
This is the first study to provide data on brain interstitial glycerol in children. CMD glycerol, particularly an increase from baseline, is associated with other markers of injury and with a significant increase in lesion size on repeat head CT. As such, it may represent a useful monitorable marker for evolving injury in paediatric TBI.
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