{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:02:43Z","timestamp":1789966963864,"version":"4.0.1"},"reference-count":40,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004331","name":"Snedkermester Sophus Jacobsen og Hustru Astrid Jacobsens Fond","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004331","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006197","name":"Fonden til L\u00e6gevidenskabens Fremme","doi-asserted-by":"publisher","award":["20\u2010L\u20100041"],"award-info":[{"award-number":["20\u2010L\u20100041"]}],"id":[{"id":"10.13039\/501100006197","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007403","name":"Dagmar Marshalls Fond","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007403","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100022183","name":"Dansk Selskab for An\u00e6stesiologi og Intensiv Medicin","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100022183","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009907","name":"Grosserer Jakob Ehrenreich og Hustru Grete Ehrenreichs Fond","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009907","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Glutamate is the main excitatory neurotransmitter in the brain, and extracellular levels of glutamate and glycerol (a breakdown product of cell damage) increase after severe acute brain injury. Previous studies report that increased intracerebral glutamate\u2014measured using cerebral microdialysis (CMD)\u2014is associated with unfavorable outcome, and that both increased glutamate and glycerol are associated with mortality in patients with severe acute brain injury. We investigated the association between CMD levels of glutamate and glycerol to episodes of neuroworsening, in\u2010hospital mortality, and functional outcome at 6\u2009months postinjury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single\u2010center retrospective cohort study included patients with subarachnoid hemorrhage (SAH) or traumatic brain injury (TBI) monitored with CMD and in whom at least five vials of microdialysate were analyzed. Using mixed\u2010effects linear regression, we compared CMD\u2010glutamate and \u2010glycerol leading up to episodes of neurological worsening (9\u201312\u2009h vs. 0\u20133\u2009h before) as well as 0\u20133\u2009h before and after episodes of neurological worsening. Additionally, CMD\u2010glutamate and \u2010glycerol were analyzed for an association with in\u2010hospital mortality and functional outcome 6\u2009months after injury, and we explored predictive thresholds of CMD\u2010glutamate and \u2010glycerol for unfavorable functional outcome 6\u2009months after brain injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 172 patients were included. Neither CMD\u2010glutamate nor \u2010glycerol changed up to or after a neuroworsening episode, nor were they associated with unfavorable outcome at 6\u2009months. We could not establish a predictive threshold of neither CMD\u2010glutamate or \u2010glycerol for 6\u2010month clinical outcomes. However, CMD\u2010glycerol was increased in patients who died during hospitalization compared to those who survived (mean difference: 55; 95% CI: 30\u201381\u2009\u03bcmol\/L).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CMD\u2010glutamate and \u2010glycerol did not predict episodes of neuroworsening or 6\u2010month functional outcome in patients with SAH or TBI. CMD\u2010glycerol was associated to in\u2010hospital mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Editorial Comment<\/jats:title>\n                    <jats:p>Serial measurements of local markers after acute brain injury might help to understand if brain condition is worsening or improving. This study assessed localized microdialysis\u2010based collection and measurement of a neurotransmitter and cell injury marker to test how well serial measures of these follow clinical brain recovery after injury. Findings confirm that more extracellular glycerol as sampled here is common in more severe brain injuries.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Trail Registration:<\/jats:bold>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">Clinicaltrials.gov<\/jats:ext-link>\n                      identifier: NCT06302244.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aas.70333","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:35Z","timestamp":1789084835000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intracerebral Glutamate and Glycerol in Severe Acute Brain Injury: Retrospective Study of Association With Neuroworsening and Outcome"],"prefix":"10.1111","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5707-8712","authenticated-orcid":false,"given":"Trine Hjorslev","family":"Andreasen","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Neuroscience Centre Copenhagen University Hospital\u2014Rigshospitalet  Copenhagen Denmark"},{"name":"Copenhagen Neurointensive Care Research Association (CONICA), Department of Neuroanaesthesiology, Neuroscience Centre Copenhagen University Hospital\u2014Rigshospitalet  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0981-0723","authenticated-orcid":false,"given":"Markus Harboe","family":"Olsen","sequence":"additional","affiliation":[{"name":"Copenhagen Neurointensive Care Research Association (CONICA), Department of Neuroanaesthesiology, Neuroscience Centre Copenhagen University Hospital\u2014Rigshospitalet  Copenhagen Denmark"},{"name":"Copenhagen Trial Unit, Centre for 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