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Open Access Original research

Matrix metalloproteinase 9 and cellular fibronectin plasma concentrations are predictors of the composite endpoint of length of stay and death in the intensive care unit after severe traumatic brain injury

Jean-Christophe Copin1236*, Marie My Lien Rebetez4, Natacha Turck5, Xavier Robin5, Jean-Charles Sanchez5, Karl Schaller5, Yvan Gasche12 and Bernhard Walder4

Author Affiliations

1 Geneva Neuroscience Center, University of Geneva, Geneva, Switzerland

2 Division of Intensive Care, University Hospitals of Geneva, Geneva, Switzerland

3 Division of Neurosurgery, University Hospitals of Geneva, Geneva, Switzerland

4 Division of Anaesthesiology, University Hospitals of Geneva, Geneva, Switzerland

5 Biomedical Proteomics Research Group, Department of Human Protein Sciences, University of Geneva Medical Center, Geneva, Switzerland

6 Centre Médical Universitaire, 1, rue Michel Servet, Genève 4, CH-1211, Switzerland

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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2012, 20:83  doi:10.1186/1757-7241-20-83

Published: 18 December 2012

Abstract

Background

The relationship between severe traumatic brain injury (TBI) and blood levels of matrix metalloproteinase-9 (MMP-9) or cellular fibronectin (c-Fn) has never been reported. In this study, we aimed to assess whether plasma concentrations of MMP-9 and c-Fn could have predictive values for the composite endpoint of intensive care unit (ICU) length of stay (LOS) of survivors and mortality after severe TBI. Secondary outcomes were the state of consciousness measured with the Glasgow Coma Scale (GCS) of survivors at 14 days and Glasgow Outcome Scale Extended (GOSE) at 3 months.

Methods

Forty-nine patients with abbreviated injury scores of the head region ≥ 4 were included. Blood was sampled at 6, 12, 24 and 48 hours after injury. MMP-9 and c-Fn concentrations were measured by ELISA. The values of MMP-9 and c-Fn, and, for comparison, the value of the GCS on the field of the accident (fGCS), as predictors of the composite outcome of ICU LOS and death were assessed by logistic regression.

Results

There was a linear relationship between maximal MMP-9 concentration, measured during the 6-12-hour period, and maximal c-Fn concentration, measured during the 24-48-hour period. The risk of staying longer than 9 days in the ICU or of dying was increased in patients with a maximal early MMP-9 concentration ≥ 21.6 ng/ml (OR = 5.0; 95% CI: 1.3 to 18.6; p = 0.02) or with a maximal late c-Fn concentration ≥ 7.7 μg/ml (OR = 5.4; 95% CI: 1.4 to 20.8; p = 0.01). A similar risk association was observed with fGCS ≤8 (OR, 4.4; 95% CI, 1.2-15.8; p = 0.02). No relationship was observed between MMP-9, c-Fn concentrations or fGCS and the GCS at 14 days of survivors and GOSE at 3 months.

Conclusions

Plasma MMP-9 and c-Fn concentrations in the first 48 hours after injury are predictive for the composite endpoint of ICU LOS and death after severe TBI but not for consciousness at 14 days and outcome at 3 months.

Keywords:
Head injury; Prediction; Outcome; Plasmatic biomarker