Predictive value of intracranial pressure- related parameters and coagulation on the prognosis in patients with traumatic brain injury.

Valor predictivo de los parámetros relacionados con la presión intracraneal y la coagulación en el pronóstico de pacientes con traumatismo craneoencefálico.

• Linna Shen Yunnan St. John's Hospital, Kunming, China. https://orcid.org/0009-0005-5283-3121
• Haibin Lu Daping Hospital, Army Medical University, Chongqing, China. https://orcid.org/0009-0008-3272-4595
• Shuibo Yang People’s Hospital of Yuxi City, Yuxi, China. https://orcid.org/0009-0008-1897-4213
• Feixiong Chen Second Affiliated Hospital of Kunming Medical University, Kunming, China. https://orcid.org/0009-0004-5243-7236

DOI: https://doi.org/10.54817/IC.v65n1a02

Keywords: brain trauma, intracranial pressure, coagulation, prognosis

Abstract

This study investigated the factors affecting the prognosis of patients with traumatic brain injury (TBI) and assessed the predictive value of intracranial pressure-related parameters and coagulation on prognosis. Seventy TBI patients admitted between January 2020 and January 2021 were categorized into good prognosis (n=42) and poor prognosis (n=28) groups according to the Glasgow Outcome Scale (GOS) score upon discharge. Factors affecting prognosis were analyzed, and differences in intracranial pressure and coagulation between the two groups were compared. The receiver operating characteristic curve (ROC) was used to calculate the predictive value of intracranial pressure-related parameters and coagulation function on prognosis. Within 24 h postoperatively, the good prognosis group had lower levels of intracranial pressure (ICP) and partial pressure of oxygen in brain tissue (PbtO2) and higher cerebral perfusion pressure (CPP) and cerebral hemodynamic parameters than the poor prognosis group (p<0.05). The good prognosis group had significantly lower prothrombin time (PT), activated partial thromboplastin time (aPTT),and prothrombin time (TT) levels and higher platelets (PLT) and fibrinogen (Fib) levels than the poor prognosis group (p<0.05). Regression analysis revealed that CPP, systolic blood flow velocity (Vs), end diastolic blood flow velocity (Vd), mean blood flow velocity (Vm), PLT, Fib were independent protective factors for the prognosis, and ICP, PbtO2, PT, APTT, and TT were risk factors for prognosis. The ROC revealed that ICP, CPP, PbtO2, Vs, Vd, Vm, APTT, PLT, Fib exhibited high diagnostic value for poor prognosis (AUC=0.732, 0.940, 0.796, 0.706, 0.914, 0.729, 0.876, 0.709, 0.866), with ICP showing the highest diagnostic sensitivity and Vd showing the highest diagnostic specificity. Intracranial pressure-related parameters and coagulation indicators are prognosis-related indexes in patients with TBI, and the prognosis and survival can be improved by controlling intracranial pressure and improving coagulation.

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