01-CSF Sur1 Is Associated With ICP and Outcome After Pediatric TBI: An Exploratory Study in Cool Kids
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Pediatrics, Neuroscience, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Benjamin Zus


Introduction/Hypothesis: Sulfonylurea Receptor 1 (Sur1) is a key contributor to cerebral edema. Sur1 inhibition is protective in multiple preclinical models of acute brain injury. In adult traumatic brain injury (TBI), Sur1 expression has been associated with cerebral edema, intracranial hypertension and contusion expansion. A phase 2 clinical trial of a Sur1 antagonist, in adult TBI patients is ongoing. Sur1 in pediatric TBI, however, remains unexplored despite a high risk of cerebral edema and unfavorable outcome.

Methods: Cerebrospinal Fluid (CSF) from 16 pediatric severe TBI patients enrolled in the Cool Kids trial and 7 non-brain injured pediatric controls was evaluated for Sur1 expression using commercially available ELISAs. CSF samples from multiple time points (up to 5) per TBI patient were tested. Linear mixed models tested for an association between mean CSF Sur1 and intracranial pressure (ICP) over the first 7 days after injury and 1-year GOS-E Peds.

Results: Median age in TBI was 132.6 months (range 9.7-176.1 months). 61% of patients were male. Median initial Glasgow coma scale (GCS) score was 7 (range 4-8). 50% of patients were randomized to hypothermia. CSF Sur1 was undetectable in all controls, but elevated in 9/16 (56.25%) TBI patients. Mean CSF Sur1 was not associated with age, sex, or hypothermia. Each 1-point increase in GCS was associated with a 1.88 ng/mL decrease in CSF Sur-1. A 1 ng/mL increase in CSF Sur-1 was associated with a 0.73 mmHg increase in ICP over 7 days (p=0.004) and with a 0.24 point increase in GOSE-Peds score over the first year after injury (p=0.004). These associations remained significant after adjusting for age, sex, hypothermia, or admission GCS individually or altogether however univariable analyses results are presented given the small sample size and risk of model overfitting with inclusion of covariates.

Conclusions: In this exploratory study, Sur1 was undetectable in controls, and variably elevated in severe TBI. This is different than adults, where although Sur1 undetectable in controls, it was consistently elevated in all severe TBI patients. Furthermore, in children, mean CSF Sur-1 was associated with both ICP and functional outcome. Targeting Sur-1 may be a viable therapeutic target in a subset of pediatric TBI patients. Further study in pediatric TBI is warranted.


Meta Tag
Content Type Presentation
Knowledge Area Pediatrics
Knowledge Area Neuroscience
Knowledge Level Advanced
Membership Level Select
Tag Traumatic Brain Injury TBI
Year 2021
SIR1 protein
pediatric traumatic brain injury
cerebrospinal fluid
intracranial pressure
functional outcomes


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