gms | German Medical Science

72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

Early predictors for intra-hospital mortality in neurosurgical intensive care unit patients with isolated traumatic brain injury

Frühzeitige Mortalitätsprädiktoren für neurochirurgische Intensivpatienten mit isoliertem Schädel-Hirntrauma

Meeting Abstract

  • presenting/speaker Michaela Friedrich - Justus-Liebig Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
  • Marco Stein - Justus-Liebig Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
  • Jasmin Nagl - Justus-Liebig Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
  • Eberhard Uhl - Justus-Liebig Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
  • Michael Bender - Justus-Liebig Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocP204

doi: 10.3205/21dgnc485, urn:nbn:de:0183-21dgnc4854

Published: June 4, 2021

© 2021 Friedrich et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Isolated traumatic brain injury (iTBI) is one of the leading causes of disability and mortality worldwide. The aim of the current study was to identify early predictors for intra-hospital mortality (IHM) in patients with iTBI.

Methods: A total of 200 patients with iTBI, admitted to our neurosurgical intensive care unit (NICU) between 09/2014 and 12/2016, were analysed retrospectively. Blood samples were taken on patients’ admission to determine various serum biomarkers. Demographic and radiological data, Glasgow Coma Scale (GCS)-Score, Abbreviated Injury Scale (AIS)-Score, AIS-Head-Score, Acute Physiology and Chronic Health Evaluation (APACHE)-II-Score up on admission, intensive care unit parameters within the first 24 hours as well as the necessity for emergency surgery were analysed. Intra-hospital outcome was determined by the modified Ranking Scale.

Results: IHM was 27.5% (55/200). Lower levels of body temperature (p<0.0001), haemoglobin (p=0.001), haematocrit (p=0.002), partial thromboplastin time (p=0.002), cholinesterase (p=0.031), albumin (p<0.0001) and GCS-Score (p<0.0001), increased APACHE II-Score (p<0.0001), higher glucose level (p<0.0001), leucocyte count (p=0.005), partial thromboplastin time (PTT) (p<0.0001), urea level (p=0.011), troponin I level (p=0.009), C-reactive protein (CRP)/Albumin-ratio (p=0.044) upon admission as well as higher norepinephrine application rate (NAR) (p<0.0001), higher inspiratory oxygen fraction (FiO2) (p=0.002) and the necessity for emergency surgery (p=0.006) within the first 24 hours of NICU treatment were univariately associated with increased IHM. Furthermore, advanced age (p<0.0001), high AIS-Head-Score (p=0.041), the need for intubation (p<0.0001) and elevated lactate levels (p=0.001) were independent predictors of IHM in the multivariate analysis.

Conclusion: A higher need of NAR and FiO2 within the first 24 hours of NICU treatment were significantly associated with increased IHM. Furthermore, elevated serum lactate levels on admission were identified as a new independent predictor. These new predictors, especially in combination with well-known serum biomarkers, could be helpful to improve risk assessment of IHM in NICU patients with iTBI.