Prognosis Of Traumatic Brain Injury Patients Research Articles

Prediction Value of Initial Serum Levels of SERPINA3 in Intracranial Pressure and Long-Term Neurological Outcomes in Traumatic Brain Injury.

Traumatic brain injury (TBI) is a severe neurological condition characterized by inflammation in the central nervous system. SERPINA3 has garnered attention as a potential biomarker for assessing this inflammation. Our study aimed to explore the predictive value of postoperative serum SERPINA3 levels in identifying the risk of cerebral edema and its prognostic implications in TBI. This study is a prospective observational study, including 37 patients with TBI who finally met our criteria. The Glasgow Outcome Scale (GOS), Levels of Cognitive Functioning (LCF), Disability Rating Scale (DRS), and Early Rehabilitation Barthel Index (ERBI) scores at six months after trauma were defined as the main study endpoint. We further calculated the ventricle-to-intracranial-volume ratio (VBR) at 6 months from CT scans. The study included patients with Glasgow Coma Scale (GCS) scores ranging from 3 to 8, who were subsequently categorized into two groups: the critical TBI group (GCS 3-5 points) and the severe TBI group (GCS 6-8 points). Within the critical TBI group, SERPINA3 levels were notably lower. However, among patients with elevated SERPINA3 levels, both the peak intracranial pressure (ICP) and average mannitol consumption were significantly reduced compared with those of patients with lower SERPINA3 levels. In terms of the 6-month outcomes measured via the GOS, LCF, DRS, and ERBI, lower levels of SERPINA3 were indicative of poorer prognosis. Furthermore, we found a negative correlation between serum SERPINA3 levels and the VBR. The receiver operating characteristic (ROC) curve and decision curve analysis (DCA) demonstrated the predictive performance of SERPINA3. In conclusion, incorporating the novel biomarker SERPINA3 alongside traditional assessment tools offers neurosurgeons an effective and easily accessible means, which is readily accessible early on, to predict the risk of intracranial pressure elevation and long-term prognosis in TBI patients.

Effect of early mobilization on the development of pneumonia in patients with traumatic brain injury in the neurosurgical intensive care unit: A historical controls study.

Pneumonia has a high incidence in traumatic brain injury (TBI) patients and lacks effective treatments. Early mobilization (EM) may be a potentially effective treatment. To explore the impact of EM on TBI-related pneumonia in the neurosurgical intensive care unit (NICU). This study was a historical control study. 100 TBI patients who received EM intervention were prospectively included as the experimental group (EM cohort), and 250 TBI patients were retrospectively included as the control group. The propensity score matching (PSM) method was employed to balance baseline and minimize potential bias. The relationship between EM and TBI-related pneumonia was investigated by univariate and multivariate logistic regression, then further determined by subgroup analysis. The influence of other variables was excluded by interaction analyses. Finally, the effect of EM on the prognosis of TBI patients was analysed by comparing the Glasgow Coma Scale (GCS) and the hospital stay. After screening, 86 patients were included in the EM cohort and 199 patients were included in the control cohort. There were obvious differences between the two cohorts at baseline, and these differences were eliminated after PSM, when the incidence of pneumonia was significantly lower in the EM cohort than in the control cohort (35.0% vs. 61.9%, p < .001). Multivariate logistic regression showed that EM was an independent risk factor for TBI-related pneumonia and was significantly associated with a decreased incidence of pneumonia. This correlation was present in most subgroups and was not affected by other variables (p for interaction >.05). Patients in the EM cohort had shorter length of ICU stay (6 vs. 7 days, p = .017) and higher GCS at discharge (12 vs. 11, p = .010). EM is a safe and effective treatment for TBI patients in NICU, which can reduce the incidence of pneumonia, help to improve prognosis and shorten the length of ICU stay. Although the utilization rate of EM is low in TBI patients for various reasons, EM is still an effective method to prevent complications. Our study confirms that a scientific and detailed EM strategy can effectively reduce the incidence of pneumonia while ensuring the safety of TBI patients, which is worthy of further research and clinical application.

Voluntary running wheel exercise induces cognitive improvement post traumatic brain injury in mouse model through redressing aberrant excitation regulated by voltage-gated sodium channels 1.1, 1.3, and 1.6

Traumatic brain injury (TBI) leads to disturbed brain discharge rhythm, elevated excitability, anxiety-like behaviors, and decreased learning and memory capabilities. Cognitive dysfunctions severely affect the quality of life and prognosis of TBI patients, requiring effective rehabilitation treatment. Evidence indicates that moderate exercise after brain injury decreases TBI-induced cognitive decline. However, the underlying mechanism remains unelucidated. Our results demonstrate that TBI causes cognitive impairment behavior abnormalities and overexpression of Nav1.1, Nav1.3 and Nav1.6 proteins inside the hippocampus of mice models. Three weeks of voluntary running wheel (RW) exercise treatments before or/and post-injury effectively redressed the aberrant changes caused by TBI. Additionally, a 10% exercise-conditioned medium helped recover cell viability, neuronal sodium current and expressions of Nav1.1, Nav1.3 and Nav1.6 proteins across cultured neurons after injury. Therefore, the results validate the neuroprotection induced by voluntary RW exercise treatment before or/and post-TBI. The RW exercise-induced improvement in cognitive behaviors and neuronal excitability could be associated with correcting the Nav1.1, Nav1.3, and Nav1.6 expression levels. The current study proves that voluntary exercise is an effective treatment strategy against TBI. The study also highlights novel potential targets for rehabilitating TBI, including the Navs proteins.

Retrospective study on the correlation between serum MIF level and the condition and prognosis of patients with traumatic head injury.

This study aimed to investigate the correlation between serum levels of macrophage migration inhibitory factor (MIF) and the condition and prognosis of patients with traumatic brain injury (TBI). A retrospective study design was used, and the clinical data of 131 TBI patients from February 2019 to January 2022 were analyzed. Patients were divided into mild (13-15 points), moderate (9-12 points), or severe (3-8 points) groups according to their Glasgow Coma Scale (GCS) score after admission. The serum levels of BDNF, MIF, and MBP in the three groups were compared, and their correlation with the severity of TBI was analyzed. Patients were then separated into a good prognosis group (4-5 points) and a poor prognosis group (≤3 points) based on their Glasgow Prognostic Score (GOS) after 6 months of follow-up. The predictive power of serum indexes and combined detection on prognosis was analyzed. Patients were classified into a mild group (n = 63), moderate group (n = 47), and severe group (n = 21) based on their GCS, with a significant difference noted in serum levels of MIF, MBP, and BDNF among patients with different degrees of severity (all P < 0.001). The MIF, MBP, and BDNF levels were lower in the mild group compared to the moderate (all P < 0.001) and severe group (all P < 0.001). Additionally, the MIF and BDNF levels in the moderate group were lower compared to the severe group (P = 0.011, P = 0.002). Patients with mild severity had lower serum MIF, MBP, and BDNF levels than those with other degrees, and these indexes were positively correlated with the severity of TBI (all P < 0.001, r = 0.62, r = 0.48, r = 0.58). Based on the GOS, patients were divided into a good prognosis group (n = 107) and a poor prognosis group (n = 24), with the levels of MIF, MBP, and BDNF in the good prognosis group being significantly lower than those in the poor prognosis group (P < 0.001, P = 0.007, P = 0.003). The area under the curve (AUC) of MIF was higher than that of MBP and BDNF in predicting the prognosis of TBI patients; however, the statistical differences were not significant (MIF vs. MBP, P = 0.239; MIF vs. BDNF, P = 0.211; BDNF vs. MBP, P = 0.899). The center line has a large displacement, CT annular cisterna compression, increased white blood cell count, MBP and BDNF were risk factors for prognosis in TBI patients (P = 0.005, P = 0.001, P = 0.005, P = 0.033, P = 0.044). The serum levels of MIF, MBP, and BDNF in TBI patients were positively correlated with the severity of the disease, and MBP, BDNF levels had predictive value in determining patient prognosis.

Troponin I New Biomarker in Traumatic Brain Injury

Mortality in traumatic brain injury (TBI) is thought to be pathology in the heart-brain axis but its effect on the prognosis of traumatic brain injury remains unclear. Our study aimed to investigate the relationship between cardiac troponin I (cTnI) level and prognosis in TBI patients. Between January 2017 and May 2021, 480 patients diagnosed with TBI, who applied to the emergency department, were retrospectively included in this multicentric study. The databases of the hospitals were examined comprehensively and the demographic, clinical, laboratory, radiological, and therapeutic data and results of the patients were obtained. The severity of trauma and clinical status was evaluated with AIS, Injury Severity Score (ISS), ASA physical status, and Glasgow Coma Scale (GCS). The severity of the trauma was evaluated with the ISS. The modified Rankin Scale (mRS) and the Glasgow Outcome Scale (GOS) at discharge were used to evaluate in-hospital clinical outcomes. cTnI levels were classified into three categories: normal (< 0.05 ng/ml), mildly elevated (0.05–0.99 ng/ml), and severely elevated (≥ 1 ng/ml). The mean age of the patients was 41.7 and 75.4% of them were men. It was observed that mortality among patients over 65 years (13.9%) increased. High cTnI was detected in 284 (59.1%) patients. Although it was not statistically significant regarding the elevation of cTnI in patients under 65 years of age (P = 0.62), the difference was significant for cTnI in patients over 65 years of age (P < 0.001). The relationship between cTnI elevation was found to be statistically significant (P < 0.001) as the severity of the trauma increased and when severe additional traumas (thoracic, abdominal, or pelvic) occurred. A high cTnI level is associated with poor prognosis in TBI patients. cTnI measurement is a useful tool for early risk stratification and accelerated care; however, further prospective studies are needed.

The combination of arterial lactate level with GCS-pupils score to evaluate short term prognosis in traumatic brain injury: a retrospective study

BackgroundThe aim of the study was to determine whether the combination of Glasgow Coma Scale (GCS) and Pupil responses score (GCSP) with arterial lactate level would be an index to predict the short term prognosis in patients with traumatic brain injury (TBI).MethodsA retrospective study was performed enrolling all TBI patients admitted to intensive care unit (ICU) from 2019 to 2020. The demographics, clinical characteristics, and arterial lactate concentration were recorded. The GCSP and arterial blood analysis (ABG) with lactate was tested as soon as the patient was admitted to ICU. The Glasgow Outcome Scale (GOS) after discharge was regarded as the clinical outcome. A new index named GCSP-L was the combination of GCSP and lactate concentration. GCSP-L was the GCSP score (range 1-15) plus the lactate score (range 0-2). The lactate score was defined based on different lactate concentrations. If lactate was below 2 mmol/L, lactate score was 0, which above 5 mmol/L was 2 and between 2 and 5 mmol/L, the score was 1. As the range of GCSP was 1-15, the range of the GCSP-L was 1 to 17. The area under receiver operating characteristic curve (AUC) was calculated to evaluate the predictive ability of GCSP, lactate and GCSP-L. Statistical significance was set when p value < 0.05.ResultsA total of 192 TBI patients were included in the study. Based on GCSP, mild, moderate, and severe TBI were 13.02, 14.06 and 72.92%, respectively. There were 103 (53.65%) patients with the lactate concentration below 2 mmol/L (1.23 ± 0.37 mmol/l), 63 (32.81%) of the range from 2 to 5 (3.04 ± 2.43 mmol/l) and 26 (13.54%) were above 5 mmol/l (7.70 ± 2.43 mmol/l). The AUC was 0.866 (95% CI 0.827-0.904) for GCSP-L, 0.812 (95% CI 0.765-0.858) for GCSP and 0.629 (95% CI 0.570—0.0.688) for lactate. The AUC of GCSP-L was higher than the other two, GCSP and lactate alone.ConclusionsThe combination of GCSP and lactate concentration can be used to predict the short term prognosis in TBI patients.

Decompressive Craniectomy vs. Craniotomy Only for Traumatic Brain Injury: A Propensity-Matched Study of Long-Term Outcomes in Neuropsychology.

BackgroundBoth decompressive craniectomy (DC) and craniotomy only (CO) are commonly performed to treat patients with traumatic brain injury (TBI) by evacuation of intracranial hemorrhage (ICH) and control intracranial pressure (ICP). The outcomes of these two procedures have been well-studied; however, most research studies have focused on physical functions. The purpose of our study is to assess long-term outcomes in neuropsychology after DC or CO in TBI patients.MethodsInformation was collected from patients with TBI who had undergone DC or CO and were then in the postoperative stable phase (6–24 months after injury). Propensity scoring matched the patients in a 1:1 ratio for demographics, cause of injury, TBI subtype, TBI severity, computed tomography (CT) findings, surgery side, and interval from TBI. We used Wechsler Adult Intelligence Scale-Chinese Revision (WAIS-RC), Wechsler Memory Scale-Chinese Revision (WMS-RC), Physical Self-maintenance Scale (PSMS), Instrumental Activities of Daily Living Scale (IADL), and Glasgow Outcome Scale-Extended (GOSE) to measure the long-term outcomes in TBI patients, especially in neuropsychology.ResultsThere were 120 TBI patients included in our study. After matching, 74 patients were paired into the DC group (n = 37) and the CO group (n = 37). There were no differences in the gender (P = 1.000), age at injury (P = 0.268), marital status (P = 0.744), pre-injury employment (P = 0.711), comorbidities (P = 1.000), education level (P = 0.969), cause of injury (P = 0.357), TBI subtype (P = 0.305), Glasgow Coma Scale (GCS) total score (P = 0.193), unconsciousness (P = 0.485), traumatic subarachnoid hemorrhage (tSAH) (P = 0.102), unresponsive pupil (P = 1.000), midline shift (P = 0.409), cisterns compressed or absent (P = 0.485), surgery side (P = 0.795), and interval from TBI (P = 0.840) between the two groups. The CO group was associated with better cognitive function in WAIS-RC OIQ (P = 0.030) and WAIS-RC FIQ (P = 0.021) and better daily function in IADL (P = 0.028) and ADL total (P = 0.030). The DC group also had a lower GOSE (P = 0.004) score compared to the CO group. No difference was observed in WAIS-VIQ (P = 0.062), WMS-RC MQ (P = 0.162), and PSMS (P = 0.319).ConclusionIn the matched cohort, patients who underwent CO had better long-term outcomes in cognitive and daily function compared with DC. Future randomized control trials are needed for intensive studies on physical and neuropsychological prognosis in TBI patients.

Temporal and spatial changes in reactive astrogliosis examined by 18F-THK5351 positron emission tomography in a patient with severe traumatic brain injury

BackgroundThe positron emission tomography (PET) radioligand 18F-THK5351 is now used to evaluate monoamine oxidase B expression in the reactive astrogliosis seen in various central nervous diseases. Traumatic brain injury (TBI) is known to induce reactive astrogliosis in the lesion site. This is a first report to examine the spatial and temporal changes in reactive astrogliosis as evaluated by 18F-THK5351 after a severe TBI.Case presentationA 27-year-old man suffering from a severe TBI with multiple brain contusions was examined using 18F-THK5351 PET/CT in the subacute and chronic phases after the injury. The first PET scan, performed 46 days after the TBI, showed intense uptake of 18F-THK5351 in and around the brain contusions. The second PET scan, performed 271 days after the TBI, showed reduced uptake of 18F-THK5351 at the original sites of the brain contusions and increased uptakes in the white matter surrounding the contusions and the corpus callosum. The patient exhibited sustained improvement of neuropsychological impairment between the two PET examinations and remarkable recovery from the severe TBI.ConclusionsThere were evident temporal and spatial changes in 18F-THK5351 uptake in the traumatized brain between the two PET examinations. These changes may have been related to the remarkable neurological recovery in this patient. The degree and distribution of reactive astrogliosis detected by 18F-THK5351 PET may be useful in assessing pathophysiology and predicting prognosis in TBI patients.

Fever as an independent prognostic factor in traumatic brain injury

Traumatic Brain Injury (TBI) patients more often than not develop fever within the first few days of their hospitalization. Studies report that causes are variable and according to the pathogenesis, fever may be harmful or protective. The study was conducted to correlate the development of fever with clinical prognosis. Throughout the study spanning 6 months, a total of 98 patients of TBI were included. In the first 48 hours, 54 patients did not develop fever (temperature &gt;37?), 20 patients recorded temperatures between 37? and 39?; and 24 patients developed high fever (39?). On regular temperature monitoring and follow up, it was found that patients developing fever relatively early during hospitalization were more likely to end up with a poor outcome (Glasgow outcome scale 4 to 5). Therefore, fever is independently a predictor of poor prognosis in TBI patients and should be managed diligently in the first few days.

Enteral combined with parenteral nutrition improves clinical outcomes in patients with traumatic brain injury

ABSTRACT Objective: To investigate the effect of nutritional support on nutritional status and clinical outcomes of patients with traumatic brain injury (TBI). Methods: Sixty-one patients with TBI from the intensive care unit and neurosurgery of Xianyang Central Hospital from 2017 to 2019 were retrospectively included. General and clinical data of the study subjects were collected. The control group (n = 28) received parenteral nutrition alone, and the observation group (n = 33) received parenteral nutrition combined with enteral nutrition. The general conditions and biochemical indicators of both groups of patients were divided into two groups of ≤8 and ≥9 for stratified analysis to compare the nutritional support status and infection complications during hospitalization Occurrence, ICU length of stay, total length of stay, total cost of stay, and prognostic indicators of the patients were analyzed and compared. Results: There were no significant differences in biochemical indicators between both groups of patients when they were discharged. Among patients with GCS ≤8 points, the incidence of lung infection in the observer was significantly higher than that in the control group (P < 0.001), but the incidence of intracranial infection, stress ulcers, and diarrhea was not statistically different from that in the control group (P = 0.739). No significant differences were observed in hospitalization time and hospitalization costs between both groups (P = 0.306 and P = 0.079, respectively). The observation group was significantly better than the control group in GSC score and long-term quality of life score (P = 0.042 and P = 0.025, respectively). When GCS was ≥ 9 points, there was no statistical difference in the incidence of lung infections and intracranial infections between both groups of patients (P = 0.800 and P = 0.127, respectively). The observation group was significantly higher than the control group in terms of length of hospital stay, nasal feeding time and hospitalization costs (P < 0.001, P < 0.001 and P = 0.006, respectively). The observation group was significantly better than the control group in GSC score and long-term quality of life score (P = 0.001 and P = 0.015, respectively). There was no significant difference in the incidence of pulmonary infection and intracranial infection between both groups of patients (P = 0.800 and P = 0.127, respectively). Conclusion: Enteral nutrition combined with parenteral nutrition intervention has a positive effect on the clinical prognosis of TBI patients.

Value of Helsinki computerized tomography scoring system in prognostic evaluation of patients with traumatic brain injury

Objective To investigate the clinical practicability and prognostic value of Helsinki CT score in patients with traumatic brain injury (TBI). Methods A retrospective case series study was conducted to analyze the clinical data of 124 TBI patients admitted to First Affiliated Hospital of Xinjiang Medical University from September 2016 to October 2018. There were 91 males and 33 females, aged 14-84 years, with an average age of 49 years. Glasgow coma score (GCS) at admission ranged from 3-8 points in 45 patients, 9-12 points in 42 patients, and 13-15 points in 37 patients. According to Glasgow outcome scale (GOS) at 6 months after injury, 26 patients were classified into the poor prognosis group with GOS of 1-3 points and 98 patients were in the good prognosis group with GOS of 4-5 points. The prognosis-related risk factors were analyzed, and the role of Helsinki CT score to predict the adverse prognosis and mortality of TBI patients in the two groups was investigated. The sensitivity and specificity of Helsinki CT Score for 6-month poor prognosis were evaluated by receiver operation characteristic (ROC) curve and area under the curve (AUC). Results Univariate analysis suggested that there were significant differences in terms of subdural hematoma, intracranial hematoma, extradural hematoma, hematoma volume >25 cm3, intraventricular hemorrhage and suprasellar cistern pressure between the poor prognosis group and good prognosis group (P 0.05). The Helsinki CT score could independently predict the adverse prognosis and mortality of TBI patients at 6 months (multivariate logistic regression: ORdeath=1.21, ORadverse prognosis=1.14). Helsinki CT score had a better predictive ability of 6-month mortality (AUC=0.85) than that of 6-month adverse prognosis (AUC=0.76), and had a predictive value for 6-month mortality and adverse prognosis. Conclusions Subdural hematoma, extradural hematoma, intraventricular hemorrhage and suprasellar cistern state (compression or disappearance) are the risk factors for the poor prognosis of TBI patients. Intraventricular hemorrhage and suprasellar cistern state are the main risk factors for predicting the mortality of 6 months. Helsinki CT score can independently predict the adverse prognosis and mortality of TBI patients at 6 months, and has relatively better value in predicting the mortality. Key words: Brain injuries; Tomography, X-ray; Helsinki CT score

Mechanism of mild hypothermia promoting nerve regeneration after traumatic brain injury in rats

Objective To investigate whether mild hypothermia can promote neurogenesis in the dentate gyrus of hippocampus and cognitive function recovery after traumatic brain injury (TBI) through inhibiting apoptosis of hippocampal neurons. Methods A total of 66 healthy adult Sprague-Dawley rats were randomly divided into sham group, TBI group and TBI+ hypothermia group, with 22 rats in each group. The rat TBI model was established using the fluid percussion device. The rats in TBI+ hypothermia group received 4-hour hypothermia therapy immediately after injury, with the target temperature of 33.5℃. Bromodeoxyuridine (BrdU) was injected into the rats' abdominal cavity to label the mitotic cells. The test of Morris water maze was used to evaluate the rats' spatial learning and memory capabilities. Immunofluorescence staining was used to observe the expression levels of BrdU, doublecortin (DCX), neuron specific nuclear protein (NeuN), cysteinyl aspartate specific proteinase 3 (caspase-3) and cleaved caspase-3 expressions in dentate gyrus of hippocampus at 7 days and 28 days after injury. Expressions apoptosis-related proteins including the factor associated suicide (FAS)/factor associated suicide ligand (FASL), B-cell lymphoma-2 (Bcl-2), caspase-3 and cleaved caspase-3 expressions were detected by Western blot assay. Results The water maze tests at 28 days after injury showed that compared with TBI group, the escape latency in TBI+ hypothermia group was significantly shorter [(24.2±5.9)s∶(18±4.1)s], and both the time in the target quadrant and the number of platform crossing were increased significantly [(24.9±6.5)s∶(31.7±5.2)s; (1.9±0.8) times∶(3.5±1.2)times](P<0.05). Compared with the sham group, in TBI group and TBI+ hypothermia group, the BrdU+ new-born cells in the dentate gyrus of hippocampus were significantly increased at 7 days after injury [(9.4±4.1)∶(33.4±3.8); (9.4±4.1)∶(45.8±5.6)], the BrdU+ /DCX+ new-born neurons were increased at 7 days after injury [(2.0±0.6)∶(9.6±1.6); (2.0±0.6)∶(19.2±3.7)], and the BrdU+ /NeuN+ mature neurons were increased at 28 days after injury [(2.6±1.0)∶(17.2±3.9); (2.6±1.0)∶(33.6±9.1)] (P<0.01). TBI group showed more obvious increase than the TBI+ hypothermia group (P<0.01). Moreover, compared with 7 days after injury, the number of BrdU+ cells at 28 days after injury was further increased in TBI+ hypothermia group but decreased in TBI group [(45.8±5.6)∶(58.8±9.2); (33.4±3.8)∶(22.0±3.5)](P<0.05 or <0.01). Compared with the sham group, the caspase-3+ NeuN+ and caspase-3+ NeuN+ apoptotic neurons were significantly increased at 7 days after injury in TBI group [(2.0±0.9)∶(11.6±2.6); (2.6±1.0)∶(10.2±2.9)] (P<0.05). Compared with the TBI group, the cleaved caspase-3+ NeuN+ apoptotic neurons were decreased in TBI+ hypothermia group [(6.6±2.0)∶(11.6±2.6)](P<0.05). Furthermore, compared with the TBI group, mild hypothermia might down-regulate the expression of FAS, FASL, cleaved caspase-3 and caspase-3 and up-regulate the expression of Bcl-2 in the hippocampus [(1.54±0.15) ∶(1.14±0.12); (1.06±0.04)∶(0.80±0.09); (0.84±0.03)∶(0.62±0.08); (0.93±0.06)∶(0.86±0.09); (0.71±0.01)∶(1.58±0.18)](P<0.05). Conclusions Mild hypothermia might inhibit apoptosis of hippocampal neurons through cleaved caspase-3, FAS/FASL and Bcl-2 pathways, thus improving the neurogenesis and maturation of neurons in the dentate gyrus of hippocampus and facilitating cognitive function recovery in rats. It indicates that the function of hypothermia in anti-apoptosis and neurogenesis and maturity of hippocampal neurons may have a potential role in predicting the prognosis of TBI patients. Key words: Hypothermia; Brain injuries; Hippocampus; Neuve regeneration; Apoptosis

Fluid administration strategies in traumatic brain injury

Fluid restriction strategies may reduce morbidity and mortality in critical care patients and are currently trending as preliminary data showed encouraging results. A positive fluid balance was related to increase morbidity and mortality in a variety of disorders (i.e., sepsis, acute respiratory distress syndrome, and postsurgical cases) as well as resulted in an increased rate of complications observed in the intensive care unit setting. Traumatic brain injury (TBI) has been managed thus far in terms of fluid resuscitation under the concept of general trauma resuscitation recommendations that favored euvolemia above all fluid balance states. Notwithstanding, scarce data exist to clarify details about fluid management strategies in TBI such as the desirable fluid balance per se and/or its impact on patients' outcomes. We, therefore, reviewed previously published data and concluded in an observational manner (by creating a visual display model) that a highly positive and/or a negative fluid balance may have a detrimental impact on the prognosis of TBI patients. Accordingly, well-designed randomized controlled trials are clearly required to investigate further and in detail the most efficacious fluid administration strategies in TBI contributing thus in the rapidly expanding field of neurocritical care.

Prognostic significance of serum translocator protein in patients with traumatic brain injury

BackgroundTranslocator protein (TP) is related to inflammation and is involved in brain injury. The objective of this study was to ascertain whether serum TP concentrations are associated with the severity and prognosis of traumatic brain injury (TBI). MethodsWe quantified the serum concentrations of TP in 106 healthy controls and 106 patients with severe TBI. Recorded prognostic variables included acute lung injury, acute traumatic coagulopathy, progressive hemorrhagic injury, posttraumatic cerebral infarction, 6-month mortality and 6-month poor outcome (Glasgow Outcome Scale score of 1–3). Trauma severity was assessed by Glasgow coma scale (GCS) score. Extent of inflammatory response was indicated by serum interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-a) and C-reactive protein (CRP) concentrations. ResultsPatients had significantly higher serum TP concentrations than controls. Among patients, serum TP concentrations strongly and independently correlated with GCS score and serum IL-6, TNF-a and CRP concentrations. Serum TP was identified as an independent predictor for the preceding prognostic variables, its prognostic predictive ability was similar to that of GCS score and it also significantly improved prognostic predictive ability of GCS score. ConclusionSerum TP may be intimately linked with in inflammation, disease progression and poor prognosis in TBI patients.

Analysis of related influential factors for prognosis of traumatic brain injury patients

Objective To explore the related factors which affect the prognosis of traumatic brain injury (TBI) patients and provide the basis for clinical diagnosis and treatment. Methods One hundred and thirty-four TBI patients were selected from May 2017 to April 2018 in the Department of Neurosurgery of Wuwei Liangzhou Hospital. Death and discharge were used as endpoint events. The patients were divided into survival group (n=103) and death group (n=31) according to their prognosis. The abbreviated injury scale (AIS), glasgow coma scale (GCS), vital signs, thrombelastography, coagulation function and Chinese DIC scoring system (CDSS) of the patients at the time of admission was completed. The measurement data were compared with the t test, the count data were compared with chi-square test and logistic regression was used for multivariate regression analysis. Results The AIS was (4.7±0.9) scores, CDSS was (7.8±1.1) scores, GCS was (5.8±1.4) scores, the R time of thrombelastography was (15.1±5.6) min in death group. The AIS was (4.3±0.8) scores, CDSS was (6.6±0.6) scores, GCS was (8.6±1.7) scores, the R time of thrombelastography was (8.6±3.4) min in survival group. Single factor analysis showed that the AIS and CDSS were higher, GCS was lower and the R time of thrombelastography was longer in death group than in survival group, and there were statistical differences between the two groups (P<0.05). The multivariate logistic regression analysis showed that GCS, CDSS and R time were the independent risk factors of the prognosis of TBI patients. The area under the receiver operating characteristic curves of GCS, CDSS and R time were 0.731, 0.648 and 0.635, respectively. Conclusion GCS, CDSS and R time can be used as predictive risk factors for prognosis of TBI patients. Key words: Craniocerebral trauma; Prognosis; Regression analysis

Effect of circadian intracranial pressure changes on prognosis of patients with traumatic brain injury

Objective To investigate the effect of intracranial pressure fluctuation on the prognosis of patients with traumatic brain injury (TBI). Methods A retrospective case series study was conducted on the clinical data of 30 patients with TBI hospitalized between June 2012 and June 2014. There were 21 males and 9 females, aged (43.0±19.8)years. After the intracranial pressure probe was implanted, the intracranial pressure of TBI patients was monitored continuously and the data were recorded per minute. A single cosine method was used in analyzing the circadian rhythm of intracranial pressure data. Furthermore, the ratio of the amplitude of the circadian parameter (A) to the median (M) value (A/M) was selected to evaluate the biologic rhythm of patients. The correlations of circadian rhythm parameter A/M with Glasgow Outcome Scale (GCS) and with extended Glasgow Outcome Scale (GOS-E) were analyzed using linear regression. Results The circadian rhythm was observed in all patients regardless of injury severity (P<0.01). The circadian rhythm parameter A/M of intracranial pressure was positively correlated with the GCS of patients at discharge (R2=0.346, F=14.797, P<0.01) and with the GOS-E (R2=0.356, F=15.502, P<0.01). Conclusion The intracranial pressure fluctuation of TBI patients follows circadian rhythm, which might be correlated with the prognosis of TBI patients. Key words: Brain injuries; Intracranial pressure; Prognosis; Biorhythm

Prognostic value of disseminated intravascular coagulation in patients with traumatic brain injury

Objective To evaluate the role of disseminated intravascular coagulation (DIC) for prognosis prediction in patients with traumatic brain injury (TBI). Methods The retrospective review collected 209 patients with moderate to severe TBI (admission GCS score of 3-12 points) emergently admitted between January 2010 and January 2014. DIC score was calculated for each patient according to the modified diagnostic criteria for DIC by the International Society of Thrombosis and Hemostasis (international DIC score) and for DIC by the Japanese Ministry of Health and Welfare (Japanese DIC score) respectively. A receiver-operating characteristic (ROC) curve analysis based on the two DIC scores was made to calculate the area under curve (AUC) for prediction of progressive hemmorhage injury (PHI) and prognosis. Results AUC (95%CI) of Japanese DIC score was 0.847(0.795-0.898), indicating a higher predictive value of PHI over other single coagulation index. International DIC score and Japanese DIC score for 6-month mortality [AUC 0.734 (95%CI 0.644-0.824) and AUC 0.708 (95%CI 0.612-0.804), respectively] and for 6-month unfavorable outcome [AUC 0.640 (95%CI 0.566-0.714) and 0.606 (95%CI 0.530-0.682), respectively] showed higher predictive value compared to other single coagulation index. When the international DIC score and Japanese DIC score were added into the predictive model of motality, the AUC were increased to 0.811 (95%CI 0.741-0.880) and 0.795 (95%CI 0.722-0.868) respectively. Conclusions Predictive value of DIC score for PHI and prognosis in TBI patients is higher than other single coagulation index. Combination of DIC score with traditional predictive model can increase the prediction ability on mortality of the TBI patients. Key words: Craniocerebral trauma; Disseminated intravascular coagulation; Prognosis; Forecasting

Autoregressive spectral analysis of cortical electroencephalographic signals in a rat model of post-traumatic epilepsy

Objectives:Post-traumatic epilepsy (PTE) is a common consequence of traumatic brain injury (TBI) and significant predictor of poor prognosis in TBI patients. To develop clinical interventions for PTE risk reduction, there is a need to elucidate the epileptogenic mechanisms induced by brain injury.Methods:The iron-induced rat model of epilepsy used here mimics many aspects of human PTE. Intracortical injection of iron results in local neuronal damage and the establishment of an epileptic focus, leading to chronic spontaneous electroencephalographic (EEG) signals and motor seizures, with progressively increasing frequency over many months. Identifying unique aspects of PTE seizure semiology for prognosis and treatment may be aided by novel methods of EEG analysis. Here, autoregressive (AR) methods were compared to the conventional fast Fourier transform (FFT) for processing EEG signals in iron-induced epilepsy.Results:Power spectra obtained using AR showed higher frequency resolution over a given epoch than the spectra obtained using FFT. Moreover, changes in total AR spectral power and frequency distribution over brief successive periods provided convenient indexes for long-term monitoring of seizures.Discussion:Autoregression analysis may prove complementary to FFT for EEG analysis in PTE patients.

Effect of hypothalamic- pituitary- adrenal axis on prognosis of patients with traumatic brain injury

Objective To observe the influence of hypothalamic- pituitary- adrenal(HPA) axis on the prognosis of patients with traumatic brain injury(TBI). Methods 140 cases of TBI were fallen into the following groups:mild group(26 cases), moderate group(34 cases),severe group(64 cases), and ultra severe group(16 cases).The serum cortisol was measured at 8∶00 am on the 3rd day after TBI.The dexamethasone suppression test was done to assay the stress response ability of HPA which might be injured in TBI.0.75 mg dexamethasone was taken orally or through a stomach tube at 00∶00 am of the 4th day post- TBI, and then the serum cortisol was assayed at 8∶00 am on the 4th day post-TBI.The rate of the pulmonary infection, average hospitalization days and Glasgow Outcome Scale (GOS) were recorded. Results The rate of HPA axis dysfunction was 11.6%, 35.3%, 64.1% and 81.3% in the mild group, moderate group, severe group and ultra severe group, respectively.The difference among the four subtypes of TBI was statistically significant(χ2trend= 27.432,P< 0.01). The rate of the pulmonary infection,average hospitalization days and GOS were respectively counted in different subtypes of TBI between the patients with normal and impaired HPA.The differences in the above items were significant(P< 0.05)between the same subtypes of TBI with or without HPA axis dysfunction. Conclusion HPA axis function relates to the prognosis of TBI patients. Key words: Hypothalamic-pituitary-adrenal axis; Traumatic brain injury; Prognosis

Predictive value of initial intracranial pressure for the prognosis of patients with traumatic brain injury

This paper aims to investigate the predictive value of initial intracranial pressure (ICP) for the prognosis of patients with traumatic brain injury (TBI). A prospective observational study was conducted in 118 TBI patients with ICP monitoring. The initial ICP [receiver operating characteristic (ROC) area = 0.725; 95%CI: 0.635-0.815] was similar to admission Glasgow Coma Scale (GCS; ROC area = 0.716; 95% CI: 0.616-0.816) or Marshall classification (ROC area = 0.690; 95% CI: 0.593-0.787) in predicting the prognosis of TBI patients. A Logistic regression analysis showed that initial ICP was associated with poor prognosis in TBI patients ( OR = 0.943, 95%CI: 0.899-0.988; P = 0.014). The initial ICP in TBI patients could be used as an independent predictor of TBI patients' outcomes. doi: 10.3969/j.issn.1672-6731.2014.08.015