Daño cerebral agudode los mecanismos patogénicos a la práctica clínica

Abstract

The detection of a marker of brain damage able to predict outcomes and detect complications early would be useful in clinical practice. Apoptosis plays an important role in the acute brain injury (ABI), and for this reason his inhibition could help to improve the prognosis of the patients. This is a prospective study in 83 patients with ABI. The blood samples were abtained simultaneously upon admission to the ICU, and 24, 48, and 72 hours after brain damage hours and the S100B was quantified. A positive correlation was found between regional (internal jugular vein bulb) and systemic (superior cava vein) levels at all the timepoints (r > 0.79; p < 0.001). Patients who presented poor outcomes had a secondary elevation of S100B at 48 hours, which could be related to the development of secondary brain damage. Regional determinations of S100B at 24 hours were best predicted poor prognosis at 6 months [AUC 0.70 (95% CI 0.54-0.84)]. Regional samples at 48 hours showed an area under ROC curve of 0.73 (95 CI 0, 58-0, 90) for the diagnosis of brain dead. The regional-systemic gradient of S100B had high specificity for predicting the development of brain death. We used an in vitro model with SH-SY5Y cells to study the effect of cyclosporine on hypothermia dopamine induced apoptosis. The proportion of apoptotic cells in culture at a temperature of 32ºC, were significantly lower than in culture at 37ºC. However, cyclosporine significantly increased the percentage of apoptotic cells.