The Correlation Between Early Serum PAI-1 Level And Injury Severity In Patients With Traumatic Brain Injury Combined With Multiple Trauma

Objective:Patients who get traumatic brain injury combined with multiple trauma are in acute and severe conditions all the time,in which multiple organs will interact with each other,thus usually causing high mortality and difficult treatments.Therefore,evaluating the patients’ conditions quickly and scientifically,making correct judgements and giving effective treatment regimens are the crutial factors to success.Injury Severity Score(ISS)is the gold standard to assess the injury severity at the moment.However,the ISS is based on the anatomical injury which may hard to get at the early stage after trauma,and doctors may calculate wrong scores under pressure,so using ISS to decide the injury severity may cause the error.Plasminogen Activator Inhibitor-1(PAI-1)is a natural fibrinolytic inhibitor in vivo and it can be synthesized by various cells.The aim of this study is to investigate the serum PAI-1 level at early stage after traumatic brain injury combined with multiple trauma,and figure out the correlation between serum PAI-1 level and injury severity,so as to provide a serum indicator to judge the injury severity.Methods:According to inclusion and exclusion criteria,50 patients with traumatic brain injury combined with multiple trauma admitted to the emergency of the First Hospital of Shanxi Medical University from February 2021 to November 2021 were selected as the research group,and 20 healthy persons from the examination center of the First Hospital of Shanxi Medical University during the same period were randomly selected as the control group.In terms of the ISS score,10 patients judged minor injury(ISS < 20)were divided into group A and 40 patients considered severe injury(ISS≥20)were divided into group B.1ml serum of each patients in the research group were collected in a 1.5ml centrifuge tube(≤8 hours from the trauma),and 1ml serum of each people in the control group were also collected in a 1.5ml centrifuge tube.All samples were labeled and then preserved at-80℃ refrigerator.Using double antibody sandwich method and PAI-1 kit to detect serum samples.SPSS 22.0 software was used to analyze the serum PAI-1 level and its correlation with ISS score,then established a multi-factor linear regression model to predict ISS score based on PAI-1 level.Results:(1)The serum PAI-1 level in the research group(931.72(824.26-1048.28)pg/ml)was significantly higher than that in the control group(723.05(690.28-754.60)pg/ml),and the difference was statistically significant(P<0.001).Meanwhile,the serum PAI-1 level in group B(949.80(890.00-1129.34)pg/ml)was significantly higher than that in group A(799.30(751.00-826.24)pg/ml),the difference was statistically significant(P<0.001).(2)Correlation analysis showed that the serum PAI-1 level in the research group was positively correlated with ISS score(r=0.772,P<0.001).Further analysis showed that the serum PAI-1 level in group B was positively correlated with ISS score(r=0.636,P<0.001).However,there was no correlation between serum PAI-1 level and ISS score in group A(r=-0.143,P=0.694).(3)The serum PAI-1 level at early stage was correlated with gender(P=0.036),age(P=0.022),hypotension(P=0.017),alcohol consumption(P=0.044)and GCS score(P=0.003).While the serum PAI-1 level was not associated with the coagulation disorders(P=0.102)or platelet levels(r=-0.157,P=0.276).(4)With ISS score as dependent variable and PAI-1 level,hypotension,alcohol consumption,age and gender as independent variables,a multiple linear regression model was established to predict ISS score.The results showed that the serum PAI-1level was still significantly correlated with ISS score(B=0.040,P < 0.001)after controlling other variables,while hypotension(P=0.380),alcohol consumption(P=0.900),age(P=0.349)and gender(P=0.147)had no significant effects on ISS score.Conclusion:The level of serum PAI-1 in patients with traumatic brain injury combined with multiple trauma was significantly increased at early stage,and the PAI-1 level was correlated with gender,age,hypotension,alcohol consumption and GCS score.Futhermore,the serum PAI-1 level at early stage in severe injury patients was positively correlated with ISS score,in other words,the serum PAI-1 level was correlated with the injury severirty,which means higher PAI-1 level was linked with higher ISS score.By contrast,the serum PAI-1 level at early stage in minor injury patients was not significantly correlated with ISS score.These results suggest that the serum PAI-1 level at early stage after trauma may represents the total damage of endothelial cells to a certain extent.In conclusion,the serum PAI-1 level at early stage after traumatic brain injury combined with multiple trauma is expected to be a serological index reflecting the burden and severity of injury,thus helping to guide treatments of post-trauma.