Cerebral Endothelial Injury in Elderly Patients With Severe Head Injury Measured by Serum Thrombomodulin and von Willebrand Factor

Atsumi, Takahiro; Araki, Takashi; Fuse, Akira; Sato, Hidetaka; Kushimoto, Shigeki; Koido, Yuichi; Kikuchi, Makoto; Yamamoto, Yasuhiro

doi:10.2176/nmc.47.383

Cited by 9 publications

(8 citation statements)

References 28 publications

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“…Age-related deterioration in cerebrovascular reactivity has been reported as a factor responsible for the poorer outcomes in elderly TBI patients (Czosnyka et al, 2005). Yokota et al (2007) have demonstrated that the serum levels of thrombomodulin and von Willebrand factor as indicators of cerebral endothelial injury and activation are significantly higher in the elderly than in younger patients at the very early phase after severe TBI. They concluded that the higher sensitivity to cerebral endothelial activation and injury in elderly patients will cause a high incidence of delayed intracranial hematoma and poorer outcomes.…”

Section: Age-related Worse Outcome In Tbimentioning

confidence: 99%

Age-Associated Increases in Poor Outcomes after Traumatic Brain Injury: A Report from the Japan Neurotrauma Data Bank

Tokutomi

Miyagi

Ogawa

et al. 2008

Journal of Neurotrauma

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Age is an important factor influencing outcome after severe traumatic brain injury (TBI). In general, the older the victim, the higher the probability of a poor outcome. To investigate the mechanism underlying the link between age and outcome, the data for 797 patients enrolled in the Japan Neurotrauma Data Bank (JNTDB), aged 6 years or older, with Glasgow Coma Scale (GCS) scores of 8 or less on admission or deterioration to that level within 48 h of impact were analyzed. Thirty-eight percent of the patients were between the ages of 40 and 69 years, and 24% of the patients were older than 69 years. Older patients had higher rates of mortality and lower rates of favorable outcome. The frequency of mass lesions which were associated with poorer outcomes significantly increased with age, but regardless of the intracranial lesion type, older patients had poorer outcomes. The GCS score and the occurrence of systemic complications did not differ significantly according to age. Multiple systemic injury was less frequent in older patients. The varied occurrence of intracranial lesion types according to age is likely caused by the disparity between the young and aged brain in the progression of secondary brain injury. Alteration in the pathophysiological response, which is related to the development of secondary brain injury in the aging brain, probably contributes to more severe and irreversible brain damage in older patients, and is thus associated with poor outcomes.

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Section: Age-related Worse Outcome In Tbimentioning

confidence: 99%

Age-Associated Increases in Poor Outcomes after Traumatic Brain Injury: A Report from the Japan Neurotrauma Data Bank

Tokutomi

Miyagi

Ogawa

et al. 2008

Journal of Neurotrauma

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“…34) As in our elderly patients, such vulnerability might be one of the reasons for long-term impairment of autoregulation and subsequent persistent cerebral hypoperfusion. The level of endothelial damage was higher in elderly patients than in younger patients, so the impairment of autoregulation might persist longer in elderly patients in our study.…”

Section: Discussionmentioning

confidence: 83%

Lower Extracellular Glucose Level Prolonged in Elderly Patients With Severe Traumatic Brain Injury: A Microdialysis Study

Yokobori

Watanabe

Matsumoto

et al. 2011

Neurol. Med. Chir.(Tokyo)

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Age may be an independent predictor of outcomes in traumatic brain injury (TBI), but the causes of the poor outcomes in elderly patients remain unclear. To clarify the differences between elderly and young patients with TBI, brain metabolism parameters were monitored with the microdialysis method in 30 patients with severe TBI (Glasgow Coma Scale scores 3-8). The microdialysis probe was inserted in the penumbra area of the brain and extracellular levels of glucose, glutamate, glycerol, lactate, and pyruvate were measured hourly for the initial 168 hours (7 days) after operation. The lactate/pyruvate ratio, which is considered to be a good indicator of neuronal ischemia, was also calculated. The patients were divided into the elderly group aged 65 years or older and the young group aged less than 65 years, and the biochemical markers were compared daily between these two groups. The value of extracellular glucose concentration was significantly lower in the elderly group than in the young group, and continued until the 7th day after injury. Moreover, the lactate/pyruvate ratio peaked on the 5th day after injury in the elderly group, later than in the young group. We concluded that neural vulnerability persisted longer in elderly patients than in young patients with TBI, and this should be considered to prevent the occurrence of additional secondary brain injury.

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“…showed that poor outcomes after TBI in elderly patients were associated with activation of the cerebral endothelium, as measured by the increased serum levels of thrombomodulin and von Willebrand factor, compared to young and middle-aged patients. [ 43 ] In another study, they also showed that the levels of von Willebrand factor paralleled plasma FDP levels. [ 44 ] These results support the hypothesis that fibrinolytic abnormalities increase in older TBI patients because of the high sensitivity of cerebral endothelial cells to trauma.…”

Section: Discussionmentioning

confidence: 98%

Age-related differences in fibrinolytic parameters in patients with acute traumatic brain injury

Nakae¹,

Yokobori²,

Takayama³

et al. 2017

Surg Neurol Int

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Background:Coagulopathy and old age have been associated with poor outcomes in traumatic brain injury (TBI) patients; however, the relationships of coagulopathy and age with the acute phase of TBI remain unclear. We hypothesized that coagulation/fibrinolytic abnormalities are more severe in older patients in the acute phase of TBI and may explain, in part, their poor outcome.Methods:We analyzed the relationship between coagulation/fibrinolytic parameters and age in the acute phase of TBI by retrospectively evaluating 274 patients with initial blood samples obtained no more than 1 hour after injury. Measurement of platelet count, prothrombin time, activated partial thromboplastin time, plasma levels of fibrinogen, and D-dimer was done in the emergency department on arrival as well as 3, 6, and 12 hours following injury. Values were compared between patients aged 16–55 years (group 1) and those aged older than 55 years (group 2) with an Abbreviated Injury Score (AIS)-head of 3–5 to identify any relationship between these parameters and age.Results:When groups 1 and 2 were matched for AIS-head, plasma levels of D-dimer in group 2 were significantly higher than those in group 1 from hospital admission to 12 hours after injury. The Glasgow Outcome Scale scores at 3 months post-injury of group 2 with AIS 4 and 5 were significantly lower than those of group 1 (both P < 0.0001).Conclusions:Fibrinolytic abnormalities are more severe in older acute-phase TBI patients, which may be a factor associated with their poor prognosis.

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Cerebral Endothelial Injury in Elderly Patients With Severe Head Injury Measured by Serum Thrombomodulin and von Willebrand Factor

Cited by 9 publications

References 28 publications

Age-Associated Increases in Poor Outcomes after Traumatic Brain Injury: A Report from the Japan Neurotrauma Data Bank

Age-Associated Increases in Poor Outcomes after Traumatic Brain Injury: A Report from the Japan Neurotrauma Data Bank

Lower Extracellular Glucose Level Prolonged in Elderly Patients With Severe Traumatic Brain Injury: A Microdialysis Study

Age-related differences in fibrinolytic parameters in patients with acute traumatic brain injury

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