Abstract：
Xanthine oxidase (XO) may be involved in the induction of oxidative stress and inflammation. We measured serum XO levels at multiple days to determine whether it is associated with the severity and prognosis of severe traumatic brain injury (sTBI). In this prospective cohort study, we quantified serum XO levels in 112 sTBI patients and 112 controls. Serum XO levels of patients were measured at admission and at days 1, 3, 5, 7, and 10 after sTBI. Extended Glasgow outcome scale scores of 1-4 at post-trauma 180 days were defined as a poor prognosis. Multivariate analysis was employed to determine the relationship between poor prognosis and serum XO levels at multiple days. Serum XO levels were significantly increased at admission among patients, afterwards elevated gradually, peaked at day 3, and then diminished gradually until day 10, and were substantially higher during 10 days in patients than in controls. Serum XO levels at 6 different days were all correlated with admission Rotterdam computed tomography (CT) scores and Glasgow coma scale (GCS) scores. Serum XO levels at 6 different days were all substantially higher in patients with poor prognosis than in those with good prognosis. Serum XO levels at days 7 and 10, but not at days 1, 3, and 5, had significantly lower area under receiver operating characteristic (AUC) than those at admission. Serum XO levels at admission and at days 1 and 3, but not at day 5, were independently associated with 180-day poor prognosis. Prognostic prediction model containing GCS scores, Rotterdam CT scores, and serum XO levels at admission (or at days 1 and 3) showed substantially higher AUC than GCS scores and Rotterdam CT scores alone. The models were visually described using nomograms, which were comparatively stable under calibration curve and were relatively of clinical benefit under decision curve. Elevated serum XO levels during early period of sTBI are more closely associated with trauma severity and clinical adverse outcomes, assuming that serum XO may serve as a potential prognostic biomarker in sTBI.
摘要：
黄嘌呤氧化酶（XO）可能参与氧化应激和炎症的诱导。我们测量了几天的血清XO水平，以确定其是否与严重创伤性脑损伤（sTBI）的严重程度和预后有关。在这项前瞻性队列研究中，我们量化了112例sTBI患者和112例对照者的血清XO水平.在入院时和sTBI后第1、3、5、7和10天测量患者的血清XO水平。创伤后180天延长格拉斯哥预后量表评分1-4分被定义为预后不良。采用多因素分析确定不良预后与多日血清XO水平之间的关系。患者入院时血清XO水平显著升高，后来逐渐升高，在第3天达到峰值，然后逐渐减少，直到第10天，并且在10天内患者明显高于对照组。6天血清XO水平均与入院鹿特丹计算机断层扫描（CT）评分和格拉斯哥昏迷量表（GCS）评分相关。预后不良的患者在6天的血清XO水平均明显高于预后良好的患者。在第7天和第10天，而不是在第1、3和5天，血清XO水平在接受者工作特征（AUC）下的面积显着低于入院时的面积。入院时以及第1天和第3天，而不是第5天的血清XO水平与180天的不良预后独立相关。包含GCS评分的预后预测模型，鹿特丹CT评分,入院时（或第1天和第3天）的血清XO水平显示，AUC明显高于GCS评分和鹿特丹CT评分。使用列线图直观地描述了模型，在校准曲线下相对稳定，在决策曲线下相对具有临床益处。sTBI早期血清XO水平升高与创伤严重程度和临床不良结局密切相关。假设血清XO可能作为sTBI的潜在预后生物标志物。
