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Temporal change of serum xanthine oxidase levels and its relation to clinical outcome of severe traumatic brain injury: a prospective cohort study

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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.

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Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to that they are personal data but are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank all participants for providing us with their clinical information.

Funding

This work is financially supported by Key Research and Development Projects of Zhejiang Province (No. 2020C03071) and the Construction Fund of Medical Key Disciplines of Hangzhou (No. OO20200485, No. OO20200055).

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  1. Tian Yan, Hao Shan, and Zefan Wang contributed equally to this work.

Authors and Affiliations

  1. The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310000, China

    Tian Yan, Hao Shan, Zefan Wang, Shengdong Zou & Ziyin Chen

  2. Department of Neurosurgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Zhejiang Province, 310006, Hangzhou, China

    Wenhua Yu, Quan Du & Xiaoqiao Dong

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  1. Tian Yan
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Contributions

W.Y., Q.D., and X.D. conceptualized and designed the study; T.Y., H.S., Z.W., S.Z., and Z.C. implemented the study and collected the data; T.Y., H.S., and Z.W. wrote the first draft of the paper and critically revised the manuscript. All the authors reviewed and approved the final draft of the manuscript. T.Y. and H.S. contributed equally to this work.

Corresponding authors

Correspondence to Quan Du or Xiaoqiao Dong.

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Ethics approval and consent to participate

This study was approved by the Institutional Review Committee of the Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine (Grant No. IRB#2021-20210603-01). The protocol was conducted in accordance with the Declaration of Helsinki and its later amends. We acquired written informed consent to participate in the current study from legal representatives of patients or controls themselves.

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Yan, T., Shan, H., Wang, Z. et al. Temporal change of serum xanthine oxidase levels and its relation to clinical outcome of severe traumatic brain injury: a prospective cohort study. Neurosurg Rev 46, 320 (2023). https://doi.org/10.1007/s10143-023-02233-8

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