Association of early dexmedetomidine exposure with brain injury biomarker levels following moderate – Severe traumatic brain injury: A TRACK-TBI study
Issued Date
2024-08-01
Resource Type
ISSN
09675868
eISSN
15322653
Scopus ID
2-s2.0-85199005759
Journal Title
Journal of Clinical Neuroscience
Volume
126
Start Page
338
End Page
347
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Clinical Neuroscience Vol.126 (2024) , 338-347
Suggested Citation
Wongsripuemtet P., Ohnuma T., Temkin N., Barber J., Komisarow J., Manley G.T., Hatfield J., Treggiari M., Colton K., Sasannejad C., Chaikittisilpa N., Ivins-O'Keefe K., Grandhi R., Laskowitz D., Mathew J.P., Hernandez A., James M.L., Raghunathan K., Miller J., Vavilala M., Krishnamoorthy V. Association of early dexmedetomidine exposure with brain injury biomarker levels following moderate – Severe traumatic brain injury: A TRACK-TBI study. Journal of Clinical Neuroscience Vol.126 (2024) , 338-347. 347. doi:10.1016/j.jocn.2024.07.003 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/99905
Title
Association of early dexmedetomidine exposure with brain injury biomarker levels following moderate – Severe traumatic brain injury: A TRACK-TBI study
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: Traumatic brain injury (TBI) triggers autonomic dysfunction and inflammatory response that can result in secondary brain injuries. Dexmedetomidine is an alpha-2 agonist that may modulate autonomic function and inflammation and has been increasingly used as a sedative agent for critically ill TBI patients. We aimed to investigate the association between early dexmedetomidine exposure and blood-based biomarker levels in moderate-to-severe TBI (msTBI). Methods: We conducted a retrospective cohort study using data from the Transforming Clinical Research and Knowledge in Traumatic Brain Injury Study (TRACK-TBI), which enrolled acute TBI patients prospectively across 18 United States Level 1 trauma centers between 2014–2018. Our study population focused on adults with msTBI defined by Glasgow Coma Scale score 3–12 after resuscitation, who required mechanical ventilation and sedation within the first 48 h of ICU admission. The study's exposure was early dexmedetomidine utilization (within the first 48 h of admission). Primary outcome included brain injury biomarker levels measured from circulating blood on day 3 following injury, including glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase-L1 (UCH-L1), neuron-specific enolase (NSE), S100 calcium-binding protein B (S100B) and the inflammatory biomarker C-reactive protein (CRP). Secondary outcomes assessed biomarker levels on days 5 and 14. Linear mixed-effects regression modelling of the log-transformed response variable was used to analyze the association of early dexmedetomidine exposure with brain injury biomarker levels. Results: Among the 352 TRACK-TBI subjects that met inclusion criteria, 50 (14.2 %) were exposed to early dexmedetomidine, predominantly male (78 %), white (81 %), and non-Hispanic (81 %), with mean age of 39.8 years. Motor vehicle collisions (27 %) and falls (22 %) were common causes of injury. No significant associations were found between early dexmedetomidine exposure with day 3 brain injury biomarker levels (GFAP, ratio = 1.46, 95 % confidence interval [0.90, 2.34], P = 0.12; UCH-L1; ratio = 1.17 [0.89, 1.53], P = 0.26; NSE, ratio = 1.19 [0.92, 1.53], P = 0.19; S100B, ratio = 1.01 [0.95, 1.06], P = 0.82; hs-CRP, ratio = 1.29 [0.91, 1.83], P = 0.15). The hs-CRP level at day 14 in the dexmedetomidine group was higher than that of the non-exposure group (ratio = 1.62 [1.12, 2.35], P = 0.012). Conclusions: There were no significant associations between early dexmedetomidine exposure and day 3 brain injury biomarkers in msTBI. Our findings suggest that early dexmedetomidine use is not correlated with either decrease or increase in brain injury biomarkers following msTBI. Further research is necessary to confirm these findings.