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Cited by 47

The DOI matches its Crossref record; 64 of the 64 references it cites were found in a registry or an index.

Serum substance P levels are associated with severity and mortality in patients with severe traumatic brain injury

Lorente, Leonardo, Martín, María M, Almeida, Teresa, Hernández, Mariano, Ramos, Luis, Argueso, Mónica, Cáceres, Juan J, Solé-Violán, Jordi, Jiménez, Alejandro·2015·Critical Care
DOI 10.1186/s13054-015-0911-zPMC PMC4424826
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Abstract

Introduction: Substance P (SP) is a member of the tachykinin family of neuropeptides, which are widely distributed throughout the central nervous system (CNS) and actively involved in inflammatory processes. SP is released early following acute injury to the CNS, promoting a neurogenic inflammatory response characterized by an increase in the permeability of the blood–brain barrier and the development of vasogenic edema. High levels of SP could lead to an exacerbated inflammatory response that could be fatal for patients with traumatic brain injury (TBI). Thus, the main goal of the present study was to determine whether serum SP levels are associated with injury severity and mortality in patients with severe TBI. Methods: This multicenter, observational, prospective study was carried out in six Spanish intensive care units and included patients with Glasgow Coma Scale (GCS) scores ≤8. Patients with an Injury Severity Score ≥10 in non-cranial aspects were excluded. Blood samples were collected on day 1 of TBI to measure serum SP levels. The endpoint was 30-day mortality. Results: We found higher serum SP levels (P=0.002) in non-surviving patients (n =27) than in surviving patients (n =73). The area under the curve for serum SP levels with regard to predicting 30-day mortality was 0.70 (95% confidence interval (CI), 0.60 to 0.79;P<0.001). Survival analysis showed that patients with serum SP levels >299 pg/ml had higher 30-day mortality than patients with lower levels (hazard ratio =3.7; 95% CI, 1.75 to 7.94;P<0.001). Multiple binomial logistic regression analysis showed that serum SP levels >299 pg/ml were associated with 30-day mortality when we controlled for APACHE II score and Marshall computed tomography lesion classification (odds ratio (OR) =5.97; 95% CI, 1.432 to 24.851;P=0.01) and for GCS score and age (OR =5.71; 95% CI, 1.461 to 22.280;P=0.01). We found a negative association between serum SP levels and GCS score (Spearman’s ρ = −0.22;P=0.03). Conclusions: We report, for the first time to our knowledge, that serum SP levels were associated with injury severity and mortality in patients with severe TBI. These results open the possibility that SP antagonists may be useful in the treatment of patients with severe TBI.

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Figures

Figure 1 Receiver operating characteristic curve analysis of serum substance P levels to predict 30-day mortality. AUC, Area under the curve; CI Confidence interval.
Figure 1 Receiver operating characteristic curve analysis of serum substance P levels to predict 30-day mortality. AUC, Area under the curve; CI Confidence interval.CC BY · PubMed Central
Figure 2 Survival curves at 30 days using serum substance P levels higher or lower than 299 pg/ml as the cutoff. CI, Confidence interval.
Figure 2 Survival curves at 30 days using serum substance P levels higher or lower than 299 pg/ml as the cutoff. CI, Confidence interval.CC BY · PubMed Central

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Research works printed but not linked: 1

  1. Palma C, Minghetti L, Astolfi M, Ambrosini E, Silberstein FC, Manzini S, et al. Functional characterization of substance P receptors on cultured human spinal cord astrocytes: synergism of substance P with cytokines in inducing interleukin-6 and prostaglandin E2 production. Glia. 1997;21:183–93. · DOI

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Metadata

Authors
Lorente, L., Martín, M. M., Almeida, T., Hernández, M., Ramos, L., Argueso, M., Cáceres, J. J., Solé-Violán, J., & Jiménez, A.
Venue
Critical Care
Publisher
Springer Science and Business Media LLC
Published
2015-12
Volume
19
Issue
1
ISSN
1364-8535
DOI
10.1186/s13054-015-0911-z
PMC
PMC4424826
Cited by
47
References
64
Language
en
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