Abstract
BackgroundDespite advances in decompressive craniectomy (DC) for the treatment of traumatic brain injury (TBI), these patients are at risk of having a poor long-term prognosis. The aim of this study was to predict 1-year mortality in TBI patients undergoing DC using logistic regression and random tree models.MethodsThis was a retrospective analysis of TBI patients undergoing DC from January 1, 2015, to April 25, 2019. Patient demographic characteristics, biochemical tests, and intraoperative factors were collected. One-year mortality prognostic models were developed using multivariate logistic regression and random tree algorithms. The overall accuracy, sensitivity, specificity, and area under the receiver operating characteristic curves (AUCs) were used to evaluate model performance.ResultsOf the 230 patients, 70 (30.4%) died within 1 year. Older age (OR, 1.066; 95% CI, 1.045–1.087; P < 0.001), higher Glasgow Coma Score (GCS) (OR, 0.737; 95% CI, 0.660–0.824; P < 0.001), higher d-dimer (OR, 1.005; 95% CI, 1.001–1.009; P = 0.015), coagulopathy (OR, 2.965; 95% CI, 1.808–4.864; P < 0.001), hypotension (OR, 3.862; 95% CI, 2.176–6.855; P < 0.001), and completely effaced basal cisterns (OR, 3.766; 95% CI, 2.255–6.290; P < 0.001) were independent predictors of 1-year mortality. Random forest demonstrated better performance for 1-year mortality prediction, which achieved an overall accuracy of 0.810, sensitivity of 0.833, specificity of 0.800, and AUC of 0.830 on the testing data compared to the logistic regression model.ConclusionsThe random forest model showed relatively good predictive performance for 1-year mortality in TBI patients undergoing DC. Further external tests are required to verify our prognostic model.
Highlights
Despite advances in decompressive craniectomy (DC) for the treatment of traumatic brain injury (TBI), these patients are at risk of having a poor long-term prognosis
DECRA demonstrated that early bifronto-temporoparietal DC decreased the length of stay in the ICU but was associated with unfavorable outcomes; RESCUEicp reported that DC in patients with TBI and refractory intracranial hypertension led to lower mortality
In our study, we found that older age, lower Glasgow Coma Score (GCS), higher D-dimer, coagulopathy, hypotension, and completely effaced basal cisterns were independent predictors of 1-year mortality in patients with TBI after DC
Summary
Despite advances in decompressive craniectomy (DC) for the treatment of traumatic brain injury (TBI), these patients are at risk of having a poor long-term prognosis. The aim of this study was to predict 1-year mortality in TBI patients undergoing DC using logistic regression and random tree models. Two randomized clinical trials have been conducted, the DECRA [5] and RESCUEicp [6] trials, which focused on the prognosis of TBI patients after DC. DECRA demonstrated that early bifronto-temporoparietal DC decreased the length of stay in the ICU but was associated with unfavorable outcomes; RESCUEicp reported that DC in patients with TBI and refractory intracranial hypertension led to lower mortality. Short-term outcome predictive scoring models, discharge status [7] and 30-day mortality [8], were well established in TBI patients with DC. It is necessary to identify the predictors of long-term mortality in TBI patients after DC to gain a better understanding of the progression of the disease, contributing to better daily care and improvements in the quality of life of patients
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