Prognosis in Traumatic Compression of the Brain

A.O. Trofimov, A.B. Kukarekin, M.Yu. Yuryev

Nizhegorodsky Research Institute of Traumatology and Orthopedics,
Municipal Neurosurgical Center, Nizhny Novgorod, Russia

 

Prognostication of outcomes in traumatic compression of the brain (TCB) is of great importance for prevention and timely correction of developing complications. Today it is attained by use of different versions of a multifactor analysis. This allows not only to reveal factors, which have a reliable effect on prognosis, but also to estimate a contribution of each of them into a prognostication process.

Studies of the last years proved participation of immune responses in the cascade of secondary cerebral injuries. However, their role in outcomes of TCB needs further clarification.

The goal of the present study was to determine an effect of a T-cell link of immunity and its indices on development of unfavorable outcomes in TCB. Our attempts were aimed at obtaining clinical-immunologic description of groups with unfavorable outcome and quantitative estimation of contribution of T-cell immunity indices into outcomes of TCB.

We selected 93 patients with TCB, treated surgically in the Nizhegorodsky Neurosurgical Center in 2000-2003. There were 92% of males and 8% of females. Their mean age was 46.7±8.6. The patients were examined in compliance with principles, typical of a neurosurgical clinic. Receptors of peripheral blood lymphocytes were estimated at the level of differentiation (CD3+, CD4+, CD8+) and activation (CD25+, CD95+, CD71+, HLA-, DR+, HLA-I+) receptors, determined with the help of a wide panel of monoclonal antibodies. All the patients were divided into groups, dependent on an outcome.

Then, discriminant and covariance analyses of the obtained matrix were carried our (Statistica 6.0). An outcome, estimated according to Glasgow Coma Scale, was chosen as a response factor. Indices of clinical-immunologic examination were considered to be predictors.

The covariance analysis showed, that an outcome of TCB was reliably dependent on the following factors (p<0.05): a level of consciousness, estimated on the basis of Glasgow Coma Scale, before and after operation; degree of brain contusion; a patient's age; a hematoma type; a volume of a compression substrate; a value of dislocation of median structures; a relative content (%) of such cells, as CD3+, CD95+, HLA-DR+,HLA-I+. We failed to reveal a reliable effect (p>0.05) of the following indices on an outcome: a compression side; lobar localization of hematoma; anisocoria presence; a relative content (%) of such cells, as CD4+, CD8+ , CD25+ , CD71+.

Our attempts to determine an effect of indices of T-cell immunity on an outcome demonstrated, that it was insignificant (an effect of each separate index - not more than 2%, a total effect - up to 7%).

The discriminant analysis showed, that a group of patients with unfavorable outcomes included casualties with severe brain contusion; multiple hematomas, localized in both hemispheres; dislocation of median structures of more than 10 mm and prevalent gross disorders of consciousness (Glasgow Coma Scale score < 8). Indices of a relative content of such cells, as CD3+, CD95+, HLA-DR+, HLA-I+, were reliably lower and differed from normal parameters more than 2-3 times.

Thus, one can conclude, that:

  1. Risk factors of unfavorable outcomes of TCB include a relative content (%) of such cells, as CD3+, CD95+, HLA-DR+, HLA-I+ (<0.05).
  2. Indices of T-cell immunity are not the main parameters in prognostication of outcomes of severe craniocerebral trauma. An effect of each separate index did not exceed 2% and their total effect was equal to 7%.