Journal Article

Systemic and cerebro-cardiac biomarkers following traumatic brain injury: an interim analysis of randomized controlled clinical trial of early administration of beta blockers

Bahey, Ahmed Abdel-Aziz, Chaudry, Irshad H., Taha, Ibrahim, Khan, Naushad, Jogol, Hisham, Siddiqui, Tariq, Alabdallat, Mohammad, Hakim, Suhail, Prabhu, Kirti S., Hammo, Abdel Aziz, Uddin, Shahab, Al-Thani, Hassan, Asim, Mohammad, Al-Ani, Mushreq, Rizoli, Sandro, El-Menyar, Ayman, Alaieb, Abubaker, Younis, Basil, Mahmood, Ismail, Kanbar, Ahad, Atique, Sajid, Ahmed, Khalid, Abdurraheim, Nuri

2024

Overview

This is an interim analysis of the Beta-blocker (Propranolol) use in traumatic brain injury (TBI) based on the high-sensitive troponin status (BBTBBT) study. The BBTBBT is an ongoing double-blind placebo-controlled randomized clinical trial with a target sample size of 771 patients with TBI. We sought, after attaining 50% of the sample size, to explore the impact of early administration of beta-blockers (BBs) on the adrenergic surge, pro-inflammatory cytokines, and the TBI biomarkers linked to the status of high-sensitivity troponin T (HsTnT). Patients were stratified based on the severity of TBI using the Glasgow coma scale (GCS) and HsTnT status (positive vs negative) before randomization. Patients with positive HsTnT (non-randomized) received propranolol (Group-1; n = 110), and those with negative test were randomized to receive propranolol (Group-2; n = 129) or placebo (Group-3; n = 111). Propranolol was administered within 24 h of injury for 6 days, guided by the heart rate (> 60 bpm), systolic blood pressure (≥ 100 mmHg), or mean arterial pressure (> 70 mmHg). Luminex and ELISA-based immunoassays were used to quantify the serum levels of pro-inflammatory cytokines (Interleukin (IL)-1β, IL-6, IL-8, and IL-18), TBI biomarkers [S100B, Neuron-Specific Enolase (NSE), and epinephrine]. Three hundred and fifty patients with comparable age (mean 34.8 ± 9.9 years) and gender were enrolled in the interim analysis. Group 1 had significantly higher baseline levels of IL-6, IL-1B, S100B, lactate, and base deficit than the randomized groups ( p  = 0.001). Group 1 showed a significant temporal reduction in serum IL-6, IL-1β, epinephrine, and NSE levels from baseline to 48 h post-injury ( p  = 0.001). Patients with severe head injuries had higher baseline levels of IL-6, IL-1B, S100B, and HsTnT than mild and moderate TBI ( p  = 0.01). HsTnT levels significantly correlated with the Injury Severity Score (ISS) (r = 0.275, p  = 0.001), GCS (r = − 0.125, p  = 0.02), and serum S100B (r = 0.205, p  = 0.001). Early Propranolol administration showed a significant reduction in cytokine levels and TBI biomarkers from baseline to 48 h post-injury, particularly among patients with positive HsTnT, indicating the potential role in modulating inflammation post-TBI. Trial registration: ClinicalTrials.gov NCT04508244. It was registered first on 11/08/2020. Recruitment started on 29 December 2020 and is ongoing. The study was partly presented at the 23rd European Congress of Trauma and Emergency Surgery (ECTES), April 28–30, 2024, in Estoril, Lisbon, Portugal.

• Publisher: Nature Publishing Group UK,Nature Publishing Group,Nature Portfolio
• Subject: 631/378 / 692/420 / 692/53 / 692/617 / Adrenergic beta-Antagonists - administration & dosage / Adrenergic beta-Antagonists - therapeutic use / Adult / Beta-blocker / Biomarkers / Biomarkers - blood / Blood pressure / Brain Injuries, Traumatic - blood / Brain Injuries, Traumatic - drug therapy / Clinical trials / Cytokines / Cytokines - blood / Double-Blind Method / Enzyme-linked immunosorbent assay / Epinephrine / Female / Glasgow Coma Scale / Head injuries / Heart rate / Humanities and Social Sciences / Humans / IL-1β / Immunoassays / Inflammation / Inflammatory cytokines / Interleukin 1 / Interleukin 6 / Male / Middle Aged / multidisciplinary / Patients / Phosphopyruvate hydratase / Placebos / Propranolol / Propranolol - administration & dosage / Propranolol - therapeutic use / S100 Calcium Binding Protein beta Subunit - blood / S100b protein / Science / Science (multidisciplinary) / Serum levels / Traumatic brain injury / Troponin / Troponin T / Troponin T - blood