Clinical role of low hemoglobin ratio in poor neurologic outcomes in infants with traumatic intracranial hemorrhage

En-Pei Lee,Shao-Hsuan Hsia,Jainn-Jim Lin,Chia-Ying Lin,Oi-Wa Chan,Han-Ping Wu

doi:10.1038/s41598-019-57334-6

Abstract

Traumatic brain injury (TBI) is the leading cause of pediatric morbidity and mortality worldwide, and half of all fatalities occur in infants aged less than 1 year. We analyzed 129 infants diagnosed with TBI complicated with intracranial hemorrhage confirmed by brain computed tomography. We defined delta hemoglobin (ΔHB) as nadir HB - age specific mean HB, and the ratio of HB (%) as ΔHB/age specific mean HB x 100. Infants with poor neurologic outcomes had a lower admission HB and ΔHB (p < 0.05). The in-hospital mortality rate was 10.1% (13 infants), and the infants who died had a significantly lower ΔHB ratio compared to the survivors. The area under the receiving operating characteristic curve (AUC) of initial Glasgow Coma Score (GCS) in predicting neurologic outcomes was higher than that of ratio of ΔHB (0.881 v.s 0.859). In multivariate logistic regression analysis with the optimal cutoff ratio of ΔHB, it remained an independent predictor for in-hospital mortality and poor neurologic outcomes at discharge and at 6 months. AUC analysis for the ratio of ΔHB for poor neurologic outcomes in infants aged from 0–6 months was 0.85 and the optimal cutoff was −30.7% (sensitivity, 69%; specificity, 92%; positive likelihood ratio (LR+), 8.24; negative likelihood ratio (LR−), 0.34); the AUC was 0.88 in infants aged from 6–12 months and the optimal cutoff was −20.6% (sensitivity, 89%; specificity, 79%; LR+, 4.13; LR−, 0.15).

Highlights

Traumatic brain injury (TBI) is the leading cause of pediatric morbidity and mortality worldwide, and half of all fatalities occur in infants aged less than 1 year
Infants with TBI are often complicated with intracranial hemorrhage (ICH) due to high vascularization and physiologically more immature brains, which can cause anemia resulting in cerebral ischemic damage
We demonstrated that a lower HB level was an independent risk factor for poor neurologic outcomes and in-hospital mortality in infants with TBI complicated with ICH

Summary

Introduction

Traumatic brain injury (TBI) is the leading cause of pediatric morbidity and mortality worldwide, and half of all fatalities occur in infants aged less than 1 year. Younger children are most at risk of TBI due to their dependency and inability to protect themselves, and half of all fatalities due to child abuse occurred in infants aged less than 1 year in 2015 in the United States[2] with TBI being the major cause. Infants with TBI are often complicated with intracranial hemorrhage (ICH) due to high vascularization and physiologically more immature brains, which can cause anemia resulting in cerebral ischemic damage. Previous studies have reported that anemia is a risk factor for poor neurologic outcomes in adults with TBI complicated with ICH13,14.

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