Effect of Selective COX-2 Inhibitor on IL-1β and Glasgow Coma Scale (GCS) Score in Moderate Traumatic Brain Injury Patients

Abstract

Glasglow Coma Scale (GCS) is the most frequently used clinical scoring for traumatic brain injury patients. The lower the GCS score is, the higher the morbidity and mortality. Neuroinflammation is one of the mechanisms of secondary brain injury. Selective cyclooxygenase (sCOX-2) inhibitors are drugs commonly used in postoperative pain which also possesses an anti-inflammatory effect. The aim of this study is to determine the role of sCOX-2 inhibitors as inflammatory process inhibitor in patients with head injury through the measurement of IL-1β and GCS score. This is a double blind randomized controlled study involving patients with moderate head injuries who underwent surgery in Dr. Hasan Sadikin General Hospital Bandung Indonesia from December 2013 to December 2015. After obtaining approval from the Research Ethics Committee of the Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, samples were divided randomly into 5 groups consisting of 6 patients: control group, COX2-group I (with a single dose of sCOX-2 inhibitor), COX2-group II (with two separate doses of sCOX-2 inhibitor), COX2-group III (with three separate doses of sCOX-2 inhibitor), and COX2-group IV (with four separate doses of sCOX-2 inhibitor four times). All patients received a standard therapy as recommended by the Traumatic Brain Foundation in 2007 as well as having their GCS, blood pressure, pulse rate, respiratory rate, oxygen saturation, temperature and blood sugar monitored preand post-operatively. Data were then analyzed using Paired Sample T-test and One-Way Anova statistical tests with a p-value of <0.05 considered as statistically significant. Results showed that there was a very significant improvement in GCS score in COX2-group II, III, IV with p values of 0.003, 0.002, and 0.001, respectively. No significant difference was found in IL-1β between COX2-1, COX2-II, COX2-III and control group (p<0.05), but IL-1β increased significantly in group COX2-IV (p=0.043). It is concluded that sCOX-2 inhibitor has a brain protective effect by improving the GCS score in patients with moderate head injury.