• L Lorente, M M Martín, A Pérez-Cejas, A F González-Rivero, M Argueso, L Ramos, J Solé-Violán, J J Cáceres, A Jiménez, and V García-Marín.
• Intensive Care Unit, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain. Electronic address: lorentemartin@msn.com.
• Med Intensiva. 2021 Apr 1; 45 (3): 131-137.

ObjectiveConfluence between the intrinsic and extrinsic apoptosis pathways is reached at the point of caspase-3 activation, which induces death cell. Higher serum caspase-3 levels have been recorded on day 1 of traumatic brain injury (TBI) in 30-day non-survivors compared to survivors. The objectives of this study therefore were to determine whether serum caspase-3 levels are persistently higher in non-survivors than in survivors, and whether these levels may be used to predict 30-day mortality.DesignA prospective observational study was carried out.SettingSix Spanish Intensive Care Units.PatientsPatients with severe isolated TBI (defined as Glasgow Coma Scale <9 points and non-cranial Injury Severity Score <10 points).InterventionsSerum caspase-3 concentrations were measured on days 1, 4 and 8 of TBI.Main Variables Of InterestThirty-day mortality was considered as the study endpoint.ResultsIn comparison with non-survivors (n=34), 30-day survivors (n=90) showed lower serum caspase-3 levels on days 1 (p=0.001), 4 (p<0.001) and 8 (p<0.001) of TBI. Analysis of the ROC curves showed serum caspase-3 concentrations on days 1, 4 and 8 of TBI to have an AUC (95% CI) in predicting 30-day mortality of 0.70 (0.61-0.78; p=0.001), 0.83 (0.74-0.89; p<0.001) and 0.87 (0.79-0.93; p<0.001), respectively.ConclusionsThe novel findings of our study were that serum caspase-3 levels during the first week of TBI were lower in survivors and could predict 30-day mortality.Copyright © 2019 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

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