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Objective <p>To investigate the dynamic changes of microtubule-associated protein 1 light chain 3 (LC3) and glutathione peroxidase 4 (GPX4) during the perioperative period in pediatric patients with severe traumatic brain injury (sTBI) and their association with prognosis.</p> Methods <p>A prospective cohort of 120 pediatric sTBI patients admitted to our Hospital from May 2022 to October 2024 was enrolled. All patients underwent traumatic brain injury surgery. Based on their 6-month postoperative outcomes, they were categorized into either the favorable prognosis group or the poor prognosis group. Propensity score matching (PSM) was employed to minimize confounding bias. Perioperative LC3 and GPX4 levels were compared between the two groups to analyze their relationship with prognosis. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of LC3 and GPX4 for prognosis in sTBI patients.</p> Results <p>Among the 120 sTBI patients, 50 (41.67%) had poor prognosis and were assigned to the poor prognosis group, while the remaining 70 were included in the favorable prognosis group. At admission, the poor prognosis group exhibited lower Glasgow Coma Scale (GCS) scores and albumin levels but higher intracranial pressure and activated partial thromboplastin time (APTT) compared to the favorable prognosis group (<i>P</i> &lt; 0.05). To control for confounding bias, PSM was applied, resulting in 74 successfully matched cases (37 per group). Post-matching univariate analysis confirmed balanced baseline covariates (<i>P</i> &gt; 0.05). Compared to preoperative levels, both groups showed decreased LC3 and increased GPX4 levels postoperatively (<i>P</i> &lt; 0.05). The poor prognosis group demonstrated higher serum LC3 levels and lower GPX4 levels at postoperative days 1, 3, and 7 compared to the favorable prognosis group (<i>P</i> &lt; 0.05). ROC analysis revealed that the area under the curve (AUC) values for serum LC3 and GPX4 in predicting prognosis at postoperative days 1, 3, and 7 all exceeded 0.7, with AUC values increasing significantly over time. The combined predictive AUC values of LC3 and GPX4 at different time points were greater than those of either biomarker alone.</p> Conclusion <p>Serum LC3 levels exhibited a declining trend, whereas GPX4 levels increased postoperatively in pediatric sTBI patients. Both biomarkers were closely associated with prognosis and may serve as potential indicators for early clinical identification of high-risk patients and precision intervention.</p>

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Dynamic monitoring of LC3 and GPX4 in children with severe craniocerebral injury during perioperative period and its relationship with prognosis

  • 期刊论文

  • 发表日期：

    2026年1月13日

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  • Peiliang Zhang,
  • Wenbo Zhang,
  • Jianbin Weng,
  • Zhipeng Shen

摘要

Objective

To investigate the dynamic changes of microtubule-associated protein 1 light chain 3 (LC3) and glutathione peroxidase 4 (GPX4) during the perioperative period in pediatric patients with severe traumatic brain injury (sTBI) and their association with prognosis.

Methods

A prospective cohort of 120 pediatric sTBI patients admitted to our Hospital from May 2022 to October 2024 was enrolled. All patients underwent traumatic brain injury surgery. Based on their 6-month postoperative outcomes, they were categorized into either the favorable prognosis group or the poor prognosis group. Propensity score matching (PSM) was employed to minimize confounding bias. Perioperative LC3 and GPX4 levels were compared between the two groups to analyze their relationship with prognosis. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of LC3 and GPX4 for prognosis in sTBI patients.

Results

Among the 120 sTBI patients, 50 (41.67%) had poor prognosis and were assigned to the poor prognosis group, while the remaining 70 were included in the favorable prognosis group. At admission, the poor prognosis group exhibited lower Glasgow Coma Scale (GCS) scores and albumin levels but higher intracranial pressure and activated partial thromboplastin time (APTT) compared to the favorable prognosis group (P < 0.05). To control for confounding bias, PSM was applied, resulting in 74 successfully matched cases (37 per group). Post-matching univariate analysis confirmed balanced baseline covariates (P > 0.05). Compared to preoperative levels, both groups showed decreased LC3 and increased GPX4 levels postoperatively (P < 0.05). The poor prognosis group demonstrated higher serum LC3 levels and lower GPX4 levels at postoperative days 1, 3, and 7 compared to the favorable prognosis group (P < 0.05). ROC analysis revealed that the area under the curve (AUC) values for serum LC3 and GPX4 in predicting prognosis at postoperative days 1, 3, and 7 all exceeded 0.7, with AUC values increasing significantly over time. The combined predictive AUC values of LC3 and GPX4 at different time points were greater than those of either biomarker alone.

Conclusion

Serum LC3 levels exhibited a declining trend, whereas GPX4 levels increased postoperatively in pediatric sTBI patients. Both biomarkers were closely associated with prognosis and may serve as potential indicators for early clinical identification of high-risk patients and precision intervention.