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Journal of Head Trauma Rehabilitation:
doi: 10.1097/HTR.0000000000000067
Original Article: PDF Only

Chronic Inflammation After Severe Traumatic Brain Injury: Characterization and Associations With Outcome at 6 and 12 Months Postinjury.

Kumar, Raj G. MPH; Boles, Jennifer A. BS; Wagner, Amy K. MD

Published Ahead-of-Print
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Abstract

Objective: Examine associations between chronic inflammatory profiles and outcome 6 to 12 months following severe traumatic brain injury (TBI).

Setting: University-affiliated level 1 trauma center and community.

Participants: Adults with severe TBI (n = 87); healthy controls (n = 7).

Design: Prospective cohort study.

Main Measures: Glasgow Outcome Scale; serum cytokines (interleukin [IL]-1[beta], IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, tumor necrosis factor [alpha]), 2 weeks to 3 months, 4- to 6-month averages, 6- and 12-month levels.

Results: Serum levels of IL-1[beta], IL-6, IL-8, IL-10, and tumor necrosis factor [alpha] were elevated over 3 months following TBI. Multivariate analysis showed that increased cytokine load score was associated with a 1.21 (95% confidence interval, 1.06-1.38) and 1.18 (95% confidence interval, 1.02-1.37) increase in odds of unfavorable Glasgow Outcome Scale score at 6 and 12 months, respectively. Also, elevated IL-6/IL-10 ratios were associated with increased odds of unfavorable outcomes at 6 months (adjusted odds ratio = 1.76; 95% confidence interval, 1.08-2.88).

Conclusions: Chronic inflammation has not been well characterized following TBI. Our subacute cytokine load score classifies individuals at risk for unfavorable outcomes following injury. Higher proinflammatory burden with IL-6, relative to the anti-inflammatory marker IL-10, is significantly associated with outcome. Further research should examine whether inflammatory genes and other inflammatory biomarkers affect risk for unfavorable outcomes and TBI complications.

(C) 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

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