Clinical And Biochemical Predictors Of Fatality In Traumatic Brain Injury

Abstract

Background: Traumatic brain injury is a global health problem, it is a major cause of devastating neurological sequelae and significant mortality. The underlying physiological events of traumatic brain injury are most likely responsible for the poor clinical outcomes seen. Traumatic brain injury often leads to changes in cerebral blood flow and cerebral perfusion resulting in cerebral ischaemia. The inflammatory response in traumatic brain injury coupled with oxidative stress changes causes a reduction in the endogenous anti-oxidants and dysfunction of the blood-brain barrier function. An understanding of the natural history of oxidative stress and inflammatory changes in traumatic brain injury can help design appropriate management protocols to reduce mortality and morbidity in these patients. While Glasgow Coma Score at admission was utilised in the initial evaluation of the state of consciousness in traumatic brain injury patients, the Glasgow Outcome Score was used in assessing clinical outcomes. This study utilized clinical and biomarker profiles to evaluate and assess the functional outcomes in patients with moderate to severe TBI. Aim of the study: The aim of this study was to identify potential clinical and biochemical parameters that are predictive of fatality in patients with moderate to severe traumatic brain injury. This study attempts to identify key predictors of fatality from clinical parameters, oxidative stress and inflammatory biomarkers in patients with moderate to severe traumatic brain injury. Methods: Patients with moderate to severe traumatic brain injury were admitted and managed at the Nelson Mandela Academic Hospital from March 2014-March 2017. At admission patient demographics including age and sex were recorded. the Glasgow Coma Score was assessed and recorded. All these patients underwent neurosurgical intervention and intensive care management for the traumatic brain injury. Blood and cerebrospinal fluid were sampled for evaluation of oxidative stress and inflammatory biomarkers during the initial 7 days in the intensive care unit but on day 14 only blood was sampled. The Glasgow outcome score was evaluated at 2 weeks and 12 weeks. Results: Out of  64-patient’s, the fatality was observed in 12.5% of them. The analysis for the fatality was done using Receiver operative curves, Cox regression and Kaplan-Meier analysis methods. There was a significant association between the age of the patients, anti-oxidants, proinflammatory markers and admission Glasgow Coma Score with fatality. Conclusion: Besides the admission Glasgow Coma Score, low anti-oxidant levels and elevated serum interleukin-1β levels were associated with fatal outcomes.

Key words: Traumatic brain injury, age, anti-oxidants,  Glasgow Outcome Score, Interleukins, fatality predictors.