Severe Traumatic Brain Injury Research Articles

Beyond Glasgow Coma Scale: Prehospital prediction of traumatic brain injury

IntroductionEarly identification of traumatic brain injury followed by timely, targeted treatment is essential. We aimed to establish the ability of prehospital Glasgow Coma Scale score alone and combined with vital signs to predict hospital-diagnosed traumatic brain injury. MethodsThis study included adults from the 2017–2020 Trauma Quality Improvement Program data set with blunt mechanism. We calculated test characteristics of prehospital Glasgow Coma Scale score ≤12 alone and Glasgow Coma Scale score combined with heart rate and systolic blood pressure for predicting (1) any traumatic brain injury and (2) moderate to severe traumatic brain injury. Diagnostic performances were calculated in all patients and older adults (≥55 years). We used decision curve analysis to determine the net diagnostic benefit of prehospital Glasgow Coma Scale score combined with heart rate + systolic blood pressure over Glasgow Coma Scale score alone. ResultsOf 1,687,336 patients, 39.1% had any traumatic brain injury, 3.7% had moderate to severe traumatic brain injury, and 9.1% had a prehospital Glasgow Coma Scale score ≤12. Prehospital Glasgow Coma Scale score ≤12 alone had a sensitivity 83.1%, specificity 93.7%, negative predictive value 99.3%, and positive predictive value 33.7% for predicting moderate to severe traumatic brain injury. Adding prehospital heart rate <65/min and systolic blood pressure >150 mm Hg to Glasgow Coma Scale score ≤12 improved the positive predictive value for moderate to severe traumatic brain injury (55.3%), with a preserved negative predictive value of 96.4%. Decision curve analysis showed the traumatic brain injury prediction model including prehospital heart rate and systolic blood pressure had the greatest net benefit across most threshold probabilities. ConclusionLess than a third of adult blunt trauma patients with a prehospital Glasgow Coma Scale score ≤12 have moderate to severe traumatic brain injury. Supplementing Glasgow Coma Scale score with prehospital vital signs improves diagnostic accuracy, potentially by filtering out patients with altered consciousness due to shock. Future work should better identify patients for traumatic brain injury–specific treatments in prehospital settings, including triage destination.

Management of severe traumatic brain injury in pediatric patients: an evidence-based approach.

Traumatic brain injury (TBI) is a major cause of death and disability worldwide. The decision-making process in the management of severe TBI must be based on the best available evidence to minimize the occurrence of secondary brain injuries. However, healthcare approaches to managing TBI patients exhibit considerable variation. Over an 18-month period, a multidisciplinary panel consisting of medical doctors, physiotherapists, nutritional therapists, and nurses performed a comprehensive review on various subtopics concerning TBI. The panel identified primary questions to be addressed using the Population, Intervention, Control, and Outcome (PICO) format and applied the Evidence to Decision (EtD) framework criteria for evaluating interventions. Subsequently, the panel formulated recommendations for the management of severe TBI in children. Fourteen evidence-based recommendations have been devised for the management of severe TBI in children, covering nine topics, including imaging studies, neuromonitoring, prophylactic anticonvulsant use, hyperosmolar therapy, sedation and analgesia, mechanical ventilation strategies, nutritional therapy, blood transfusion, and decompressive craniectomy. For each topic, the panel provided clinical recommendations and identified research priorities. This review offers evidence-based strategies aimed to guide practitioners in the care of children who suffer from severe TBI.

Severe Traumatic Brain Injury Outcomes In Patients With Premorbid Psychiatric Illness

ObjectiveIndividuals with psychiatric illnesses (PI) have increased rates of traumatic brain injury (TBI). Nonetheless, the influence of underlying PI on TBI outcomes is poorly understood. MethodsWe analyzed the medical records of 633 adult-severe TBI (sTBI) patients admitted to our institution between 2010-2021. We identified patients with premorbid PI (Psych(+) group, n=129) and a subset with only a substance use disorder (SUD(+) group, n=60) and compared them to patients without PI (Psych(-) group, n=480). Outcome measures included discharge Glasgow Coma Scale (GCS), length of stay (LOS), in-hospital survival, and Glasgow Outcome Scale-Extended (GOS-E). ResultsThe Psych(+) group had increased in-hospital survival (69.8% v. 55.0%, P=0.003) and fewer patients with severe (3-8) discharge-GCS (28.7% v. 46.0%, P<0.001). The SUD(+) group had increased in-hospital survival (70.0% v. 55.0%, P=0.028) and fewer patients with severe discharge-GCS (28.3% v. 46.0%, P=0.009). However, the Psych(+) (21.0 v. 10.0 days, P<0.001) and SUD(+) (16.0 v. 10.0 days, P=0.011) groups had longer LOS. The Psych(+) group had a higher mean GOS-E at discharge (2.7 v. 2.4, P=0.004), six-months (3.8 v. 3.0, P=0.006) and one-year (3.4 v. 2.3, P=0.027). The SUD(+) group also had a higher mean GOS-E at discharge (2.8 v. 2.4, P=0.034), six months (3.8 v. 3.0, P=0.035), and one year (3.5 v. 2.3, P=0.008). Additionally, there were no significant differences in injury severity or CT scan findings. ConclusionsIndividuals with PI and SUD appeared to have better outcomes but more complicated hospital stays following sTBI. Future studies should investigate the mechanisms underlying these outcomes.

Effect of Prone Position Ventilation in Patients with Severe Craniocerebral Injury Complicated with Pulmonary Infection

Objective: To investigate the effects of prone ventilation in patients with severe traumatic brain injury combined with pulmonary infection. Methods: A total of 100 patients with severe traumatic brain injury combined with pulmonary infection in the hospital were randomly divided into a prone ventilation group and a conventional ventilation group, with 50 patients in each group. The Glasgow Coma Scale (GCS) score, APACHE II score, sputum culture results, oxygenation indicators, and prognosis were compared between the two groups. Data were processed using SPSS 25.0 statistical software, and t-tests and chi-square tests were used to compare continuous and categorical variables, respectively. Results: The experimental group showed better oxygenation indicators, a lower positive rate of sputum cultures, and reduced intracranial pressure compared to the control group (all P &lt; 0.05). Multivariate Cox regression analysis indicated that GCS score, APACHE II score, and prone ventilation were independent risk factors affecting patient prognosis (all P &lt; 0.05). Conclusion: Prone ventilation can improve oxygenation, reduce the risk of pulmonary infection, and decrease intracranial pressure in patients with severe traumatic brain injury combined with pulmonary infection, thereby improving patient prognosis. GCS score and APACHE II score can serve as important indicators for prognostic evaluation.

Heart Rate Variability and Cerebral Autoregulation in Patients with Traumatic Brain Injury with Paroxysmal Sympathetic Hyperactivity Syndrome.

Severe traumatic brain injury (TBI) can lead to transient changes in autonomic nervous system (ANS) functioning and development of paroxysmal sympathetic hyperactivity (PSH) syndrome. Clinical manifestation of ANS disorders may be obscured by therapeutic interventions in TBI. This study aims to analyze ANS metrics and cerebral autoregulation in patients with PSH syndrome to determine their significance in early prognostication. This single-center retrospective study investigated the relationship between changes in ANS metrics, cerebral autoregulation, and PSH syndrome. Arterial blood pressure and intracranial pressure signals were monitored for 5 days post TBI. ANS metrics included time and frequency domain heart rate variability (HRV) metrics. Cerebral autoregulation was assessed using the pressure reactivity index. Sixty-six patients with severe TBI (median age 33 [interquartile range 26-50] years) were analyzed, and PSH was confirmed in nine cases. Impairment of cerebral autoregulation was observed in 67% of patients with PSH and 72% without the syndrome. Patients with PSH had higher HRV in the low-frequency range (LF; 253 ± 178 vs. 176 ± 227 ms2; p = 0.035) and lower heart rates (HRs; 70 ± 7 vs. 78 ± 19 bpm; p = 0.027) compared to those without PSH. A receiver operating characteristic curve analysis indicated that HR (area under the curve(AUC) = 0.73, p = 0.006) and HRV in the LF (AUC = 0.70, p = 0.009) are moderate predictors of PSH. In the multiple logistic regression model for PSH, diffuse axonal trauma (odds ratio(OR) = 10.82, 95% confidence interval(CI) = 1.70-68.98, p = 0.012) and HR (OR =0.91, 95% CI 0.84-0.98, p = 0.021) were significant factors. Elevated HRV in the LF and decreased HR may serve as early predictors of PSH syndrome development, particularly in patients with diffuse axonal trauma. Further research is needed to investigate the utility of the cerebral autoregulation-ANS relationship in PSH prognostication.

Aberrant error monitoring in traumatic brain injuries: A meta-analysis of event-related potential studies

ObjectiveAlthough individuals with traumatic brain injuries (TBI) often manifest altered error monitoring, evidence using event-related potentials (ERPs) to index these cortical processes is inconsistent. Therefore, this meta-analysis study aimed to comprehensively compare the error-related negativity (ERN) and error positivity (Pe) between individuals with TBI and healthy controls (HC) from the existing literature. MethodsLiterature search was performed using PubMed/MEDLINE, Web of Science, and Cochrane Library. The effect sizes (Hedges' g) in the comparisons of ERN and Pe amplitudes between TBI and HC groups were employed by a random-effect, inverse-variance weighted model. The effects of age, TBI severity and experimental tasks on both ERP components were also examined. ResultsRandom-effect models showed decreased ERN (g = 0.361, p = 0.010), but intact Pe (g = 0.105, p = 0.443), in those with TBI compared to HC. A further analysis revealed that the adult patients (g = 0.326, p = 0.038), but not the youth patients, showed significant reduction of ERN as compared to the HC. However, we did not find moderating effects of TBI severity and experimental paradigms on either ERN or Pe. ConclusionsERN and Pe reflect separate neurophysiological mechanisms and different aspects of error monitoring in TBI. Our findings suggest that attenuated ERN amplitude may be an electrophysiological parameter of error monitoring deficits in TBI.

Use of extracorporeal membrane oxygenation during a decompressive hemicraniectomy for severe traumatic brain injury: illustrative case.

Decompressive hemicraniectomy (DHC) can be a life-saving treatment for patients with severe traumatic brain injury (TBI) with a focal mass lesion who develop refractory elevated intracranial pressure (ICP). Nonetheless, successful completion of this procedure requires maintaining hemodynamic and respiratory stability. Extracorporeal membrane oxygenation (ECMO) use in patients with respiratory or cardiac failure is well described in the literature and has become routinely used in patients with refractory hypoxia unresponsive to traditional mechanical ventilation strategies, but few cases of its use have been reported in the neurosurgical literature. Herein, the authors describe a unique case in which a man presented after an unwitnessed fall that caused severe TBI without a focal mass lesion. The patient subsequently developed medically refractory elevated ICP secondary to traumatic cerebral edema. He required DHC, but the procedure could only be completed safely with the utilization of intraoperative ECMO. As more is learned about the techniques and pitfalls of ECMO, its indications are rapidly expanding. The case presented describes the safe use of ECMO during a major neurosurgical procedure, showing that the technique can be completed safely and offering a therapeutic option for effectively addressing refractory hypoxia and hypercarbia in patients with severe TBI who require urgent or emergency neurosurgical procedures. https://thejns.org/doi/10.3171/CASE24264.

A Combination of Low Doses of Lithium and Valproate Improves Cognitive Outcomes after Mild Traumatic Brain Injury.

The prevalence of mild traumatic brain injury (mTBI) is high compared with moderate and severe TBI, comprising almost 80% of all brain injuries. mTBI activates a complex cascade of biochemical, molecular, structural, and pathological changes that can result in neurological and cognitive impairments. These impairments can manifest even in the absence of overt brain damage. Given the complexity of changes triggered by mTBI, a combination of drugs that target multiple TBI-activated cascades may be required to improve mTBI outcomes. It has been previously demonstrated that cotreatment with the U.S. Food and Drug Administration (FDA)-approved drugs lithium plus valproate (Li + VPA) for 3 weeks after a moderate-to-severe controlled cortical impact injury reduced cortical tissue loss and improved motor function. Since both lithium and valproate can exhibit toxicity at high doses, it would be beneficial to determine if this combination treatment is effective when administered at low doses and for a shorter duration, and if it can improve cognitive function, after a mild diffuse TBI. In the present study, we tested if the combination of low doses of lithium (1 mEq/kg or 0.5 mEq/kg) plus valproate (20 mg/kg) administered for 3 days after a mild fluid percussion injury can improve hippocampal-dependent learning and memory. Our data show that the combination of low-dose Li + VPA improved spatial learning and memory, effects not seen when either drug was administered alone. In addition, postinjury Li + VPA treatment improved recognition memory and sociability and reduced fear generalization. Postinjury Li + VPA also reduced the number of anti-ionized calcium binding adaptor molecule 1 (Iba1)-positive microglia counted using a convolutional neural network, indicating a reduction in neuroinflammation. These findings indicate that low-dose Li + VPA administered acutely after mTBI may have translational utility to reduce pathology and improve cognitive function.

Incidence and predictors of neuropsychiatric manifestations following a traumatic brain injury at referral hospitals in Dodoma, Tanzania: A protocol of a prospective longitudinal observational study.

Traumatic Brain Injury (TBI) is any injury to the brain resulting from an external force leading to complications. TBI affects 27-69 million people yearly, with high incidence in low- and middle-income countries (LMICs), mainly attributed to motor traffic accidents. Within three to six months following moderate-to-severe TBI, the relative risk of any psychiatric disorder is significantly higher than in the general population. Post-TBI neuropsychiatric disorders include depression with a prevalence of up to 53%, apathy up to 72%, Posttraumatic stress disorder (26%), anxiety (9%), manic symptoms (5-9%) and psychosis (3 to 8%). This study aims to determine the incidence and predictors of post-TBI neuropsychiatric manifestations among patients admitted at Referral hospitals in Dodoma. This is a prospective longitudinal observational study in which patients admitted with moderate to severe TBI will be recruited. Patients will be followed for six months, the diagnostic MINI International Neuropsychiatric Interview (MINI) tool will be used to assess TBI, and the severity and progression of symptoms will be evaluated using PHQ-9 for depressive symptoms, GAD-7 for anxiety symptoms, PCL-5 for Posttraumatic Stress Disorders (PTSD), MoCA for cognitive assessment, AES for apathy and YMRS for manic symptoms at one, three and six months. Logistic regression will be analysed to determine the association between predictors and neuropsychiatric outcomes. Given the dearth of understanding of the burden of neuropsychiatric complications and associated outcomes in sub-Saharan Africa, the study will shed light on the incidence and factors contributing to post-TBI neuropsychiatric complications and, thus, provide a platform for further research and design of necessary interventional programs for the population at risk.

Time-Dependent Association of Preinjury Anticoagulation on Traumatic Brain Injury-Induced Coagulopathy: A Retrospective, Multicenter Cohort Study

BACKGROUND AND OBJECTIVES: The impact of preinjury anticoagulation on coagulation parameters over time after traumatic brain injury (TBI) has remained unclear. Based on the hypothesis that preinjury anticoagulation significantly influences the progression and persistence of TBI-induced coagulopathy, we retrospectively examined the association of preinjury anticoagulation with various coagulation parameters during the first 24 hours postinjury in 5 periods. METHODS: Data from the Japanese registry of patients with TBI aged ≥65 years admitted between 2019 and 2021 were used. Time since injury was classified into 5 categories through a graphical analysis of coagulation parameters. We examined the association between preinjury anticoagulation and the platelet count, prothrombin time-international normalized ratio (PT-INR), activated partial thromboplastin time (APTT), D-dimer level, and fibrinogen level during each period by analysis of covariance using 10 clinical factors as confounding factors. RESULTS: Data from 545 patients and 795 blood tests were analyzed. The patients' mean age was 78.9 years, and 87 (16%) received anticoagulation therapy. The preinjury anticoagulation group had significantly greater Rotterdam computed tomography scores and poorer outcomes at discharge than the control group, with significantly lower D-dimer levels and higher fibrinogen levels. Analysis of covariance revealed significant associations between the D-dimer level and preinjury anticoagulation within 2 to 24 hours postinjury, APTT and preinjury anticoagulation within 1 to 24 hours, and PT-INR and preinjury anticoagulation throughout all periods up to 24 hours postinjury. CONCLUSION: Despite more severe TBI signs and poorer outcomes, the preinjury anticoagulation group had significantly lower D-dimer levels, especially within 2 to 24 hours postinjury. Thus, D-dimer levels during this period may not reliably represent TBI severity in patients receiving anticoagulation therapy before injury. Preinjury anticoagulation was also associated with an elevated PT-INR and prolonged APTT from early to 24 hours postinjury, highlighting the importance of aggressive anticoagulant reversal early after injury.

Modified Revised Trauma–Marshall Score as a Proposed Tool in Predicting the Outcome of Moderate and Severe Traumatic Brain Injury

Modified Revised Trauma–Marshall Score as a Proposed Tool in Predicting the Outcome of Moderate and Severe Traumatic Brain Injury

Assessment of the sentiments expressed by traumatic brain injury patients and caregivers: A qualitative study based on in-depth interviews

IntroductionTraumatic Brain Injury (TBI) is a significant public health concern that causes death, disability, and economic burden. Its repercussions affect physical, cognitive, emotional, and behavioral aspects of long-term care needs. Despite improvements in communication among multidisciplinary teams, the management of TBI remains fragmented. ObjectiveThis study aimed to assess patients and caregivers’ experiences through sentiment analysis. Materials and methodsA qualitative cross-sectional study utilized structured topic modeling (STM) to analyze in-depth interview data. The study involved 29 patients with TBI and 27 caregivers in Madrid (Spain), using a survey design. The interviews were conducted, transcribed, and coded independently over 5 months. Sentiments such as anticipation, fear, and emotional concerns were analyzed using three dictionaries. The STM analysis identified four key concepts: desire for independence, potential improvement, need for injury information, and psychological consequences. STM diagnostic graphs were used to determine the number of topics relevant to the evaluation of patient and caregiver concerns. Furthermore, an analysis was conducted across four topics. ResultsThe average age of the patients was 44.2 ± 14.9 years (69 % males). Regarding TBI severity, 59 % of patients had severe TBI, whereas the remaining 41 % had experienced moderate TBI. Among the caregivers, the majority were parents (30 %), partners (24 %), or siblings (24 % each). Among the 51 participants, sentiments were analyzed using three dictionaries. While there were no significant age differences (Z = 0.24, p = 0.815), the STM model was adjusted for significant sex differences (p = 0.017) between patients and relatives. Anticipation and fear prevailed in both groups, highlighting the shared emotional patterns. DiscussionThe analysis of diagnostic graphs indicated the optimal number of topics for evaluation, emphasizing key concerns across different phases of TBI. Patients' main worries shifted from physical symptoms to limitations in daily life and independence. Caregivers highlighted the importance of staff interactions, misinformation challenges, and the need for psychological care. ConclusionKey patient concerns, including dependency on daily activities, limitations in autonomy, and caregiver burden, emphasize crucial areas for enhancement in multidisciplinary treatment. Moreover, the lack of long-term psychological support is a significant barrier to optimal patient and caregiver well-being.

Trauma-induced coagulopathy across age pediatric groups: A retrospective cohort study evaluating testing and frequency.

Trauma-induced coagulopathy (TIC) is associated with negative outcomes. Pediatric TIC has been described most often in older children. Children undergo normal developmental hemostasis, but it is unknown how this process impacts the risk of TIC across childhood. To understand variations in coagulation testing and TIC across pediatric age groups. We evaluated testing patterns of coagulation studies at presentation and over the first 72 h of hospitalization by pediatric age group at a large, Level I trauma center, 2015-2020. The frequency of TIC was determined using published, age-specific reference ranges and controlling for injury severity. We performed subgroup analyses of those with isolated severe traumatic brain injury (TBI) and those who presented directly from the scene of injury. Data from 2409 pediatric patients were available; 333 patients had isolated severe TBI. Children <1 year were least likely to be tested for TIC at presentation and over the first 72 h, even among the most injured. Fibrinogen testing was uncommon, regardless of injury severity. TIC was common: 22% of patients had TIC at presentation and 35% by 72 h. Greater injury severity was associated with TIC. Children 1-4 and 5-9 years had a higher frequency of TIC at presentation and over 72 h compared to older children in the least injured cohort. We saw no difference in frequency of TIC between age groups in the subset with isolated severe TBI. Using age-specific criteria, patients most often met TIC criteria by INR/PT, followed by platelet count, and least commonly by aPTT. The presence of TIC was associated with in-hospital mortality (OR 4.10, 95% CI 2.06-8.17). Significant sampling bias exists in clinical data collection among injured children and adolescents. Contrary to previous reports and using age-specific TIC criteria, younger children are not at lower risk of TIC than older children when controlling for injury severity.

Determination of the Perpetrator-Victim Position in a Case of Severe Traumatic Brain Injury due to a Less-Lethal Weapon Projectile, Based on Brain Injuries

Less-lethal (or non-lethal) weapons cause lethal and non-lethal injuries; this depends on many factors, including the shot distance and the modifications made to the operation of the weapon and the projectiles. This type of weapon has a similar shape to a firearm, shares the same physical and chemical operating principle and uses the combustion of a chemical substance to eject the projectile. In technical terms, the only difference is the projectile. Currently with the changes in weapons and projectiles, it is difficult to make a correlation. Just like lethal firearm projectiles and due to their operation, they leave macroscopic gunshot residues such as powder tattooing or soot deposition, only occasionally a contusion ring. In addition, there is a variety in the appearance of the entrance wounds. Therefore, it is very important to process the scene and carefully dissect the external wound and the surrounding area and, if possible, the recovery of the projectile. We present a case where a non-penetrating superficial injury to the skull produced trauma consistent with a coup contrecoup brain injury, which allows us to identify the perpetrator-victim position.

Days at Home After Traumatic Brain Injury: Moving Beyond Mortality to Evaluate Patient-Centered Outcomes Using Population Health Data.

Administrative data are invaluable for assessing outcomes at the population level. However, there are few validated patient-centered outcome measures that capture morbidity following traumatic brain injury (TBI) using these data. We sought to characterize and validate days at home (DAH) as a measure to quantify population-level outcomes after moderate to severe TBI. We additionally assessed the earliest feasible outcome assessment period for patients with TBI using this outcome measure. This multicenter retrospective cohort study used linked health administrative data sources to identify adults with moderate to severe TBI presenting to trauma centers in Ontario, Canada, between 2009 and 2021. DAH at 180 days (DAH180 days) reflects the total number of days spent alive and at home excluding the days spent institutionalized across care settings. Construct validity was determined using hierarchical quantile regression to assess the associations between clinical and injury covariates with DAH180 days. Predictive validity was assessed using Spearman rank correlation. We estimated minimally important difference (MID) in DAH180 days to aid with outcome measure interpretability. There were 6,340 patients who met inclusion criteria. Median DAH180 days was 70 days (interquartile range 0-144). Mortality occurred in 2,162 (34.1%) patients within 90 days following injury. Patients in the lower DAH180 days group were more commonly older (absolute standardized difference [ASD] = 0.68) with higher preinjury health resource utilization (ASD = 0.36) and greater injury severity (ASD = 0.81). Increased baseline health resource utilization (-10.1 days, 95% CI -17.4 to -2.8, p = 0.0041), older age (-4.6 days, 95% CI -5.7 to -3.4, p < 0.001), higher cranial injury severity (-84.6 days, 95% CI -98.3 to -71.0, p < 0.001), and major extracranial injuries (-14.2 days, 95% CI -19.5 to -8.93, p < 0.001) were significantly associated with fewer DAH180 days. DAH180 days was positively correlated with DAH at up to 3 years (r = 0.91, 95% CI 0.90-0.92) and negatively correlated with direct health care expenditure (rs = -0.89, 95% CI -0.88 to -0.90). The average MID estimated from anchor-based and distribution-based methods was 18 days. We validate DAH180 days as a potentially useful outcome measure with construct, predictive, and face validity in a population with moderate to severe TBI. Given the intensity of acute care requirements for patients with TBI, our work highlights DAH180 days as a feasible and sufficiently responsive outcome measure.

Predictive value of triglyceride glucose index in acute kidney injury in patients with severe traumatic brain injury

Background At present, the relationship between the Triglyceride-glucose index (TyG index) and Acute kidney injury (AKI) in traumatic brain injury patients in the Intensive Care Unit (ICU) is still unclear. Currently, the relationship between TyG index and AKI occurred within 7 days in the ICU is a highly researched and trending topic. Objective In this study, we conducted in-depth exploration of the relationship between the development of AKI in traumatic brain injury (TBI) patients in the ICU and changes in TyG index, as well as its relevance. Methods A cross-sectional study was conducted with a total of 492 individuals enrolled in the Medical Information Mart for Intensive Care IV(MIMIC-IV) database. Multivariate model logistic regression, smoothed curve fitting and forest plots were utilized to confirm the study objectives. The predictive power of the TyG index for outcome indicators was assessed using subject work characteristics (ROC) curves. As well as comparing the Integrated Discriminant Improvement Index and the Net Reclassification Index of the traditional forecasting model with the addition of the TyG index. Results Of all eligible subjects, 55.9% were male and the incidence of AKI was 59.3%. There was a statistically significant difference in the incidence of AKI within 7 days in the ICU between the different TyG index groups. The difference between TyG index and the risk of AKI within 7 days in the ICU remained significant after adjustment for logistic multifactorial modeling (OR = 2.07, 95% CI = 1.41–3.05, P < 0.001). A similar pattern of associations was observed in subgroup analyses (P values for all interactions were greater than 0.05). The addition of TyG index to the traditional risk factor model improved the predictive power of the risk of AKI within 7 days in ICU (P < 0.05). Conclusion The findings of this study demonstrate a strong association between the TyG index and the occurrence of AKI within 7 days in ICU patients. The TyG index can potentially be used as a risk stratification tool for early identification and prevention of AKI. Implementing preventive strategies targeting patients with a high TyG index may help reduce the burden of AKI in the ICU. Further prospective studies are warranted to validate these findings and explore the clinical utility of the TyG index in AKI prevention.

Long-term hypothermia amplified neuroprotection by antagonizing intracranial pressure rebound after severe traumatic brain injury in rats.

Long-term hypothermia has been reported to prevent intracranial pressure (ICP) rebound in clinical patients, but the duration for hypothermia and the corresponding ICP data are not available. This study investigated the optimal duration of long-term hypothermia in traumatic brain injury (TBI) rats, and observed the effect on ICP and neurological function. In this study, we established a rat severe TBI model with electronic Controlled Cortical Injury device, and implemented hypothermia (33 °C) for different durations. The motor function of the rats in each group was evaluated by beam walking test and inclined-grid climbing test, brain water content was calculated by the wet-dry weight method, Evan's blue staining was used to measure the blood-brain barrier (BBB) permeability, the change of hippocampal neurons was observed by Nissl staining, the expressions of BrdU, NeuN, and CD86 positive cells were detected by immunofluorescence staining, and the expressions of Bcl-2, Bax, iNOS, IL-10, and Arg-1 were detected by Western blot. We found that therapeutic hypothermia improved neurological recovery after TBI with declining ICP, reducing brain edema, decreasing BBB permeability, promoting neurogenesis, inhibiting apoptosis, and regulating inflammation. Moreover, 48 h hypothermia amplified the neuroprotective effect after injury on the basis of 4 or 24 h hypothermic treatment. Both 4 and 24 h hypothermia led to ICP rebound during or after rewarming, whereas 48 h hypothermia completely abolished ICP rebound. Our study suggests that long-term hypothermia amplifies neuroprotection after TBI by antagonizing ICP rebound.

Predicting Vasospasm and Early Mortality in Severe Traumatic Brain Injury: A Model Using Serum Cytokines, Neuronal Proteins, and Clinical Data.

Prediction of patient outcomes after severe traumatic brain injury (sTBI) is limited with current clinical tools. This study aimed to improve such prognostication by combining clinical data and serum inflammatory and neuronal proteins in patients with sTBI to develop predictive models for post-traumatic vasospasm (PTV) and mortality. Fifty-three adult civilian patients were prospectively enrolled in the sTBI arm of the Surgical Critical Care Initiative (SC2i). Clinical, serum inflammatory, and neuronal protein data were combined using the parsimonious machine learning methods of least absolute shrinkage and selection operator (LASSO) and classification and regression trees (CART) to construct parsimonious models for predicting development of PTV and mortality. Thirty-six (67.9%) patients developed vasospasm and 10 (18.9%) died. The mean age was 39.2 years; 22.6% were women. CART identified lower IL9, lower presentation pulse rate, and higher eotaxin as predictors of vasospasm development (full data area under curve (AUC) = 0.89, mean cross-validated AUC = 0.47). LASSO identified higher Rotterdam computed tomography score and lower age as risk factors for vasospasm development (full data AUC 0.94, sensitivity 0.86, and specificity 0.94; cross-validation AUC 0.87, sensitivity 0.79, and specificity 0.93). CART identified high levels of eotaxin as most predictive of mortality (AUC 0.74, cross-validation AUC 0.57). LASSO identified higher serum IL6, lower IL12, and higher glucose as predictive of mortality (full data AUC 0.9, sensitivity 1.0, and specificity 0.72; cross-validation AUC 0.8, sensitivity 0.85, and specificity 0.79). Inflammatory cytokine levels after sTBI may have predictive value that exceeds conventional clinical variables for certain outcomes. IL-9, pulse rate, and eotaxin as well as Rotterdam score and age predict development of PTV. Eotaxin, IL-6, IL-12, and glucose were predictive of mortality. These results warrant validation in a prospective cohort.

Prognostic value of soluble programmed death-1 and soluble programmed death ligand-1 in severe traumatic brain injury patients

Patients with traumatic brain injury (TBI) frequently exhibit concomitant immunosuppression. In this study, we evaluated the predictive values of soluble programmed death-1 (sPD-1) and soluble programmed death ligand-1 (sPD-L1) in patients with severe TBI. Peripheral blood sPD-1 and sPD-L1 levels were measured within 48 h of patient admission. A total of 20 healthy volunteers and 82 patients were enrolled in this study. The levels of sPD-1 and sPD-L1 were upregulated in patients with severe TBI (P < 0.001). They were significantly increased in the post-TBI severe pneumonia group and among non-survivors (P < 0.001). The area under the curves (AUCs) for sPD-1 and sPD-L1 levels to predict severe pneumonia were 0.714 and 0.696, respectively, and the AUCs to predict mortality were 0.758 and 0.735. The levels of sPD-1 and sPD-L1 are correlated with the GCS scores at admission, APACHE II scores, length of MV, and time elapsed to mortality. The levels of sPD-1 and sPD-L1 emerged as independent predictive factors for severe pneumonia and mortality. This study demonstrates that upregulation of sPD-1 and sPD-L1 in severe TBI patients is significantly associated with severe pneumonia and mortality, suggesting their potential as predictive biomarkers for these outcomes.

Candidate Molecular Biomarkers of Traumatic Brain Injury: A Systematic Review.

Traumatic brain injury (TBI) is one of the leading causes of mortality and disability among young and middle-aged individuals. Adequate and timely diagnosis of primary brain injuries, as well as the prompt prevention and treatment of secondary injury mechanisms, significantly determine the potential for reducing mortality and severe disabling consequences. Therefore, it is crucial to have objective markers that indicate the severity of the injury. A number of molecular factors-proteins and metabolites-detected in the blood immediately after trauma and associated with the development and severity of TBI can serve in this role. TBI is a heterogeneous condition with respect to its etiology, clinical form, and genesis, being accompanied by brain cell damage and disruption of blood-brain barrier permeability. Two oppositely directed flows of substances and signals are observed: one is the flow of metabolites, proteins, and nucleic acids from damaged brain cells into the bloodstream through the damaged blood-brain barrier; the other is the infiltration of immune cells (neutrophils and macrophages) and serological proteins. Both flows aggravate brain tissue damage after TBI. Therefore, it is extremely important to study the key signaling events that regulate these flows and repair the damaged tissues, as well as to enhance the effectiveness of treatments for patients after TBI.