Change of serum levels of thioredoxin in patients with severe traumatic brain injury

Background: Thioredoxin (TRX), a potent anti-oxidant, is released during inflammation and oxidative stress. The purpose of this study was to establish the relationship between serum TRX concentrations and trauma severity and outcome in severe traumatic brain injury (STBI). Methods: We determined serum TRX concentrations in 112 patients and 112 controls. Multivariate analyses were performed to analyze the predictive factors of 1-week mortality, 6-month mortality and 6-month unfavorable outcome. The predictive values were investigated under receiver operating characteristic curves. Results: Serum TRX concentrations were markedly higher in patients than in controls (19.1 +/- 7.8 ng/ml vs. 8.0 +/- 2.3 ng/ml, P < 0.001). There was a significant negative association between serum TRX concentrations and Glasgow coma scale (GCS) scores (r = 0.543, P < 0.001). Increased TRX was identified as an independent prognostic marker of 1-week mortality [Odds ratio (OR), 1.220; 95% confidence interval (Cl), 1.101-1.367; P < 0.001], 6-month mortality (OR, 1.201; 95% Cl, 1.097-1.324; P < 0.001) and 6-month unfavorable outcome (OR, 1.189; 95% CI, 1.090-1.311; P < 0.001). TRX concentrations improved area under curve of GCS scores for 6-month unfavorable outcome, but not for 1-week mortality and 6-month mortality. Conclusions: Increased serum TRX concentration, associated highly with trauma severity and poor outcome, might be a novel prognostic marker in patients with STBI. (C) 2015 Elsevier B.V. All rights reserved.