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Differential Disruption of Blood–Brain Barrier in Severe Traumatic Brain Injury

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Abstract

Background

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Traumatic brain injury (TBI) is a significant cause of death and disability in young adults, but not much is known about the incidence and characteristics of blood–brain barrier (BBB) dysfunction in this group. In this proof of concept study, we sought to quantify the incidence of BBB dysfunction (defined as a cerebrospinal fluid (CSF)–plasma albumin quotient of ≥0.007) and examine the relationship between plasma and CSF levels of proteins and electrolytes, in patients with severe TBI.

Methods

We recruited 30 patients, all of whom were receiving hypertonic 20 % saline infusion for intracranial hypertension and had external ventricular drains in situ. Simultaneous CSF and blood samples were obtained. Biochemical testing was performed for sodium, osmolality, potassium, glucose, albumin, immunoglobulin-G, and total protein.

Results

Eleven patients (37 %) showed evidence of impairment of passive BBB function, with a CSF–plasma albumin quotient of ≥0.007. There were strong positive correlations seen among CSF–plasma albumin quotient and CSF–plasma immunoglobulin-G quotient and CSF–plasma total protein quotient (r = 0.967, P < 0.001 and r = 0.995, P < 0.001, respectively). We also found a higher maximum intracranial pressure (24 vs. 21 mmHg, P = 0.029) and a trend toward increased mortality (27 vs. 11 %, P = 0.33) in patients with BBB disruption.

Conclusions

In summary, passive BBB dysfunction is common in patients with severe TBI, and may have important implications for effectiveness of osmotherapy and long-term outcomes. Also, our results suggest that the CSF–plasma total protein quotient, a measurement which is readily available, can be used instead of the CSF–plasma albumin quotient for evaluating BBB dysfunction.

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Acknowledgments

JRB was supported by a Practitioner Fellowship from the Royal Perth Hospital Medical Research Foundation.

Conflict of interest

Melanie M. Saw, Jenny Chamberlain, Michelle Barr, Matt P.G. Morgan, John R. Burnett, and Kwok M. Ho declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Intensive Care Unit, Fremantle Hospital, PO Box 480, Fremantle, WA, 6959, Australia

    Melanie M. Saw

  2. Intensive Care Unit, Royal Perth Hospital, GPO Box X2213, Perth, WA, 6001, Australia

    Jenny Chamberlain, Michelle Barr & Kwok M. Ho

  3. School of Medicine, Cardiff University, Henry Wellcome Building, Heath Park, Cardiff, CF14 4XN, UK

    Matt P. G. Morgan

  4. Department of Clinical Biochemistry, PathWest Laboratory Medicine, Royal Perth Hospital, Perth, WA, Australia

    John R. Burnett

  5. School of Medicine and Pharmacology, The University of Western Australia (M570), 35 Stirling Highway, Crawley, WA, 6009, Australia

    John R. Burnett

  6. School of Population Health, The University of Western Australia, Perth, WA, Australia

    Kwok M. Ho

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  1. Melanie M. Saw
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Correspondence to Melanie M. Saw.

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Saw, M.M., Chamberlain, J., Barr, M. et al. Differential Disruption of Blood–Brain Barrier in Severe Traumatic Brain Injury. Neurocrit Care 20, 209–216 (2014). https://doi.org/10.1007/s12028-013-9933-z

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