Association of Serum Uric Acid Level  with the Severity of Brain Injury and  Patient’s Outcome in Severe Traumatic  Brain Injury

Hatefi, Masoud; Dastjerdi, Masoud Moghadas; Ghiasi, Bahareh; Rahmani, Asghar

doi:10.7860/jcdr/2016/21918.8993

Cited by 6 publications

(9 citation statements)

References 30 publications

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“…The predictive and therapeutic role of uric acid has been widely studied in brain injury patients including ischemic stroke, intracerebral hemorrhage, and TBI [ 12 , 33 , 34 ]. One study found that low SUA level within four hours after initial injury was associated with increased mortality in TBI patients [ 33 ]. Another study made a conclusion that low SUA level which indicated more consumption by injured brain tissue was beneficial for a favorable outcome in TBI patients [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

The Predictive Value of Serum Uric Acid on Acute Kidney Injury following Traumatic Brain Injury

Wang

et al. 2020

BioMed Research International

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Backgrounds. Acute kidney injury (AKI) is a prevalent nonneurological complication in patients with traumatic brain injury (TBI). We designed this study to explore the association between serum uric acid (SUA) level and the occurrence of AKI following TBI. Methods. This is a retrospective single-center study. A total of 479 patients admitted with TBI were included in this study. We utilized SUA and other risk factors for AKI to construct a predictive model by performing multivariate logistic regression. 374 patients and 105 patients were, respectively, divided into a training set and validation set. The predictive value of the single SUA and constructed model was evaluated by drawing a receiver operating characteristic (ROC) curve. AKI was diagnosed according to the KIDGO criteria. Results. 79 (21.12%) patients were diagnosed with AKI in the training cohort. The patients in the AKI group are older than those in the non-AKI group (p=0.01). And the Glasgow Coma Scale (GCS) of the AKI group was lower than that of the non-AKI group (p<0.001). In a multivariate logistic regression analysis, we found that heart rate (p=0.041), shock (p=0.018), serum creatinine (p<0.001), and serum uric acid (SUA) (p<0.001) were significant risk factors for AKI. Bivariate correlation analyses showed that serum creatinine was moderately positively correlated with SUA (r=0.523, p<0.001). Finally, the area under the receiver operating characteristic curve (AUC) of SUA for predicting AKI in the training set and validation set was 0.850 (0.805-0.895) and 0.869 (0.801-0.938), respectively. Conclusions. SUA is an effective risk factor for AKI following TBI. Combining SUA with serum creatinine could more accurately identify TBI patients with high risk of developing AKI.

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Section: Discussionmentioning

confidence: 99%

The Predictive Value of Serum Uric Acid on Acute Kidney Injury following Traumatic Brain Injury

Wang

et al. 2020

BioMed Research International

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“…Some studies have found that a low GCS was related to a low UA level in patients with TBI, suggesting that UA may have some function in the recovery from consciousness. 8 It has also been found that administration of urate could reduce striatal or cortical damage and preserve neurological function in patients with cerebral ischemia. 5,6 Although the precursor of UA inosine improves the outcome of TBI in animal models, changes in sUA and its role in patients with TBI remain controversial.…”

Section: Renal Filtration and Reabsorption Assessmentmentioning

confidence: 99%

“…5,6 Although the precursor of UA, inosine, has been found to produce a better recovery from traumatic brain injury )TBI( in animal models with similar metabolic injury, the role of uric acid remains unclear. Some clinical studies on severe TBI as well as subarachnoid hemorrhage )SAH( patients identified decreased sUA in these patients, 7,8 while other research mentioned increased sUA in patients with TBI. 9 In patients with cerebral tumors, surgery may also trigger inflammatory and oxidative injuries resulting in neurological dysfunction.…”

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confidence: 99%

Decreased serum uric acid in patients with traumatic brain injury or after cerebral tumor surgery

Zheng

Liu

et al. 2021

NSJ

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Objectives: To investigate changes in sUA in patients with TBI or patients after cerebral tumor surgery and the possible mechanism of these changes. Methods: This prospective cohort study enrolled patients with TBI or underwent cerebral tumorOriginal Articles surgery at West China Hospital, China, from November 2014 to May 2018. Serum UA )sUA( levels, urine excretion, UA oxidant product allantoin and other clinical parameters were assessed.Results: 100 patients were enrolled for analysis. sUA in patients with TBI or underwent cerebral tumor surgery started to decline from day 1 after injury or surgery compared to control. This decreasing trend continued from day 3 )143.2±59.3 μmol/L, 188.8±49.4 μmol/L vs 287.3±80.2 μmol/L, p<0.0001( until day 7. No difference in urinary UA excretion was found in the TBI group or cerebral tumor surgery group. Urine allantoin and the allantoin to sUA ratio of the TBI group decreased on day 3 compared with the control group. The structural equation model showed that the sUA level was related to the Glasgow coma score )GCS( )r=0.5383, p<0.0001(, suggesting the potential association of UA with consciousness level, as well as serum protein and electrolytes including albumin, calcium and phosphate. Conclusion:The sUA was decreased in patients with TBI or underwent cerebral tumor surgery.

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“…UA confers neuroprotection against GIE as a peroxynitrite scavenger (Scott, Cuzzocrea, Genovese, Koprowski, & Hooper, 2005; Yu, Bruce‐Keller, Goodman, & Mattson, 1998) and by upregulating glutamate transporters on astroglia (Du, Chen, Tseng, Eisenberg, & Firestein, 2007). Previous studies have demonstrated the protective role of UA after central nervous system injuries, including traumatic brain injury (Hatefi, Dastjerdi, Ghiasi, & Rahmani, 2016), stroke (Yu et al, 1998), and SCI (Du et al, 2007; Scott et al, 2005). However, while physiological levels of UA are important for protection against oxidative stress, UA imbalances can lead to disease.…”

Section: Introductionmentioning

confidence: 99%

Uric acid released from poly(ε‐caprolactone) fibers as a treatment platform for spinal cord injury

Singh

Khaliq

Patel

et al. 2020

J Tissue Eng Regen Med

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Spinal cord injury (SCI) is characterized by a primary mechanical phase of injury, resulting in physical tissue damage, and a secondary pathological phase, characterized by biochemical processes contributing to inflammation, neuronal death, and axonal demyelination. Glutamate‐induced excitotoxicity (GIE), in which excess glutamate is released into synapses and overstimulates glutamate receptors, is a major event in secondary SCI. GIE leads to mitochondrial damage and dysfunction, release of reactive oxygen species (ROS), DNA damage, and cell death. There is no clinical treatment that targets GIE after SCI, and there is a need for therapeutic targets for secondary damage in patients. Uric acid (UA) acts as an antioxidant and scavenges free radicals, upregulates glutamate transporters on astrocytes, and preserves neuronal viability in in vitro and in vivo SCI models, making it a promising therapeutic candidate. However, development of a drug release platform that delivers UA locally to the injured region in a controlled manner is crucial, as high systemic UA concentrations can be detrimental. Here, we used the electrospinning technique to synthesize UA‐containing poly(ɛ‐caprolactone) fiber mats that are biodegradable, biocompatible, and have a tunable degradation rate. We optimized delivery of UA as a burst within 20 min from uncoated fibers and sustained release over 2 h with poly(ethylene glycol) diacrylate coating. We found that both of these fibers protected neurons and decreased ROS generation from GIE in organotypic spinal cord slice culture. Thus, fiber mats represent a promising therapeutic for UA release to treat patients who have suffered a SCI.

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Association of Serum Uric Acid Level with the Severity of Brain Injury and Patient’s Outcome in Severe Traumatic Brain Injury

Cited by 6 publications

References 30 publications

The Predictive Value of Serum Uric Acid on Acute Kidney Injury following Traumatic Brain Injury

The Predictive Value of Serum Uric Acid on Acute Kidney Injury following Traumatic Brain Injury

Decreased serum uric acid in patients with traumatic brain injury or after cerebral tumor surgery

Uric acid released from poly(ε‐caprolactone) fibers as a treatment platform for spinal cord injury

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