Impact of cerebrospinal fluid levels of serum amyloid protein A1,CXC chemokine ligand 10,and P38 protein on intracranial infection and prognosis in traumatic brain injury

Liang Chundong; Song Wanli; Zhang Haijun; Zhang Huayuan; Xu Xiahui

doi:10.11850/j.issn.1009-122X.2025.07.003

Abstract：Objective To investigate the relationship between cerebrospinal fluid(CSF)levels of serum amyloid protein A1(SAA1),CXC chemokine ligand 10(CXCL10)and P38 protein and both intracranial infection and prognosis in patients with traumatic brain injury(TBI).Methods Clinical data of 70 TBI patients who developed intracranial infection after surgery(infection group)were analyzed retrospectively.Another 90 TBI patients who underwent surgical treatment during the same period without developing intracranial infection were selected as the control group.The CSF levels of SAA1,CXCL10 and P38 protein were compared between the two groups.The diagnostic value of these three indicators for intracranial infection was analyzed using the receiver operating characteristic(ROC)curve.Based on the Glasgow Outcome Scale(GOS)score at three months post-treatment,patients in the infection group were divided into a good prognosis group(GOS≥4 points,n=44)and an poor prognosis group(GOS≤3 points,n=26).A multivariate logistic regression model was used to analyze the risk factors for poor prognosis in TBI patients with postoperative intracranial infection.Results The CSF levels of SAA1 and CXCL10 were higher in the infection group than in the control group,while P38 protein levels was lower,with all differences being statistically significant(all P<0.05).The area under the curve(AUC)values for SAA1,CXCL10,P38 protein,and their combined application in diagnosing postoperative intracranial infection in TBI patients were 0.759,0.827,0.640,and 0.921,respectively.The CSF levels of SAA1 and CXCL10 were higher in the poor prognosis group than in the good prognosis group,while P38 protein levels were lower,with all differences being statistically significant(all P<0.05).The proportion of patients with an operation time≥2 h and the proportion of patients with open cranial injuries were higher in the poor prognosis group than in the good prognosis group,while GCS scores and serum albumin levels were lower,with all differences being statistically significant(all P<0.05).The GCS score at admission,serum albumin level,and CSF P38 protein level were protective factors for the prognosis of TBI patients with intracranial infection(all P<0.05),while open cranial trauma,CSF SAA1,and CXCL10 were risk factors for poor prognosis(all P<0.05).Conclusions Elevated CSF levels of SAA1 and CXCL10,compared to decreased P38 protein levels,exhibit higher diagnostic value for postoperative intracranial infection in TBI patients.Elevated CSF levels of SAA1 and CXCL10 and decreased P38 protein levels are also associated with a poor prognosis in TBI patients with intracranial infection.