Systemic and cerebro-cardiac biomarkers following traumatic brain injury: an interim analysis of randomized controlled clinical trial of early administration of beta blockers.

Humans Brain Injuries, Traumatic / drug therapy Adrenergic beta-Antagonists / administration & dosage Biomarkers / blood Male Female Adult Middle Aged Troponin T / blood Propranolol / administration & dosage Double-Blind Method Glasgow Coma Scale Cytokines / blood S100 Calcium Binding Protein beta Subunit / blood

Beta-blocker Biomarkers Inflammatory cytokines Traumatic brain injury Troponin T

Journal

Scientific reports

ISSN: 2045-2322

Titre abrégé: Sci Rep

Pays: England

ID NLM: 101563288

Informations de publication

Date de publication:
23 Aug 2024

Historique:

received: 14 03 2024

accepted: 16 08 2024

medline: 24 8 2024

pubmed: 24 8 2024

entrez: 23 8 2024

Statut: epublish

Résumé

This is an interim analysis of the Beta-blocker (Propranolol) use in traumatic brain injury (TBI) based on the high-sensitive troponin status (BBTBBT) study. The BBTBBT is an ongoing double-blind placebo-controlled randomized clinical trial with a target sample size of 771 patients with TBI. We sought, after attaining 50% of the sample size, to explore the impact of early administration of beta-blockers (BBs) on the adrenergic surge, pro-inflammatory cytokines, and the TBI biomarkers linked to the status of high-sensitivity troponin T (HsTnT). Patients were stratified based on the severity of TBI using the Glasgow coma scale (GCS) and HsTnT status (positive vs negative) before randomization. Patients with positive HsTnT (non-randomized) received propranolol (Group-1; n = 110), and those with negative test were randomized to receive propranolol (Group-2; n = 129) or placebo (Group-3; n = 111). Propranolol was administered within 24 h of injury for 6 days, guided by the heart rate (> 60 bpm), systolic blood pressure (≥ 100 mmHg), or mean arterial pressure (> 70 mmHg). Luminex and ELISA-based immunoassays were used to quantify the serum levels of pro-inflammatory cytokines (Interleukin (IL)-1β, IL-6, IL-8, and IL-18), TBI biomarkers [S100B, Neuron-Specific Enolase (NSE), and epinephrine]. Three hundred and fifty patients with comparable age (mean 34.8 ± 9.9 years) and gender were enrolled in the interim analysis. Group 1 had significantly higher baseline levels of IL-6, IL-1B, S100B, lactate, and base deficit than the randomized groups (p = 0.001). Group 1 showed a significant temporal reduction in serum IL-6, IL-1β, epinephrine, and NSE levels from baseline to 48 h post-injury (p = 0.001). Patients with severe head injuries had higher baseline levels of IL-6, IL-1B, S100B, and HsTnT than mild and moderate TBI (p = 0.01). HsTnT levels significantly correlated with the Injury Severity Score (ISS) (r = 0.275, p = 0.001), GCS (r = - 0.125, p = 0.02), and serum S100B (r = 0.205, p = 0.001). Early Propranolol administration showed a significant reduction in cytokine levels and TBI biomarkers from baseline to 48 h post-injury, particularly among patients with positive HsTnT, indicating the potential role in modulating inflammation post-TBI.Trial registration: ClinicalTrials.gov NCT04508244. It was registered first on 11/08/2020. Recruitment started on 29 December 2020 and is ongoing. The study was partly presented at the 23rd European Congress of Trauma and Emergency Surgery (ECTES), April 28-30, 2024, in Estoril, Lisbon, Portugal.

Identifiants

DOI: 10.1038/s41598-024-70470-y PMID: 39179700

pubmed: 39179700

doi: 10.1038/s41598-024-70470-y

pii: 10.1038/s41598-024-70470-y

doi:

Substances chimiques

Adrenergic beta-Antagonists 0

Biomarkers 0

Troponin T 0

Propranolol 9Y8NXQ24VQ

Cytokines 0

S100 Calcium Binding Protein beta Subunit 0

Banques de données

ClinicalTrials.gov

['NCT04508244']

Types de publication

Journal Article Randomized Controlled Trial

Langues

eng

Sous-ensembles de citation

Pagination

19574

Subventions

Organisme : The BBTBB-RCT is funded by the Medical Research Center at Hamad Medical Corporation, Doha, Qatar under the category of grant funding 'Internal Research Grant Competition' (IRGC-05-SI-18-293).

ID : RGC-05-SI-18-293

Informations de copyright

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