Serum RIPK1, Acute Lung Injury, and Outcomes in Severe Traumatic Brain Injury: A Multicenter Prospective Study

Area of Science:

• Neuroscience
• Immunology
• Critical Care Medicine

Background:

• Receptor-interacting protein kinase-1 (RIPK1) is a key regulator of necroptosis implicated in acute brain injury (ABI) and acute lung injury (ALI).
• Understanding the role of RIPK1 in severe traumatic brain injury (sTBI) is crucial for predicting patient outcomes.

Purpose of the Study:

• To investigate serum RIPK1 levels in sTBI patients.
• To determine the prognostic implications of serum RIPK1 levels.
• To explore the mediating effect of ALI on the relationship between RIPK1 and patient outcomes.

Main Methods:

• A multicenter prospective study involving 158 sTBI patients requiring decompressive craniectomy and 100 healthy controls.
• Serum RIPK1 levels were measured and correlated with clinical data including Glasgow Coma Scale (GCS), pupil status, and basal cisternal shapes.
• Neurological impairment was assessed using the Extended Glasgow Outcome Scale (GOSE) at 180 days post-trauma.

Main Results:

• sTBI patients exhibited significantly higher serum RIPK1 levels compared to controls, with higher levels correlating with lower GCS scores and worse injury indicators.
• RIPK1 levels were linearly associated with increased risks of 180-day mortality, overall survival, poor prognosis (GOSE 1-4), and ALI.
• RIPK1 independently predicted these outcomes and demonstrated high discriminatory efficiency, with ALI partially mediating the association between RIPK1, death, and poor prognosis.

Conclusions:

• Elevated serum RIPK1 levels in sTBI are linked to trauma severity, poor outcomes, and ALI.
• RIPK1 serves as a valuable serological prognostic predictor in sTBI.
• ALI partially mediates the relationship between RIPK1 levels and mortality/poor prognosis in sTBI patients.