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Abstract
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BACKGROUND: Abnormal hematological parameters associated with unfavourable neurologic outcomes in Traumatic Brain Injury (TBI) have been studied in isolation. We intended to study whether there are any additional parameters that improve the standard prognostic models in TBI.
MATERIALS AND METHODS: This prospective observational study, conducted in a tertiary neurological care centre, included adult patients with moderate and severe isolated head injury. Laboratory and clinical parameters were noted at admission and the Glasgow Outcome Score-Extended (GOSE) of the patients was assessed after 6 months. Multiple logistic regression was conducted using fixed coefficients of the IMPACT (International Mission for Prognosis and Analysis of Clinical Trials) and CRASH (Corticosteroid Randomization after Significant Head Injury) prognostic models. The new composite models were compared with the original models.
RESULTS: Ninety-six patients were studied. The parameters with relatively good predictability for mortality were an elevated International Normalized Ratio (INR) [Area under curve (AUC) 0.69, odds ratio (OR) 13.2], total leukocyte count (TLC) (AUC 0.68, OR 1.15) and transfusion of blood products (AUC 0.72, OR 6.43). Addition of these led to a statistically small improvement in the predictions of the IMPACT and CRASH models. Neutrophil-lymphocyte ratio was not a good predictor of mortality or morbidity (AUC 0.58 and 0.47, respectively).
CONCLUSION: INR, TLC, and transfusion of blood products were found to be predictors of mortality and unfavourable neurologic outcome in TBI at six months. Their addition to the IMPACT and CRASH prognostic models resulted in a modest improvement in the prediction of outcome in TBI.
Language: en |