Article
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
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Published: | June 4, 2021 |
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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.