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

Investigación Clínica Pub Date : 2024-02-17 DOI:10.54817/ic.v65n1a02

Linna Shen, Haibin Lu, Shuibo Yang, Feixiong Chen

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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 catego-rized 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 coagula-tion between the two groups were compared. The receiver operating charac-teristic 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 intracra-nial pressure (ICP) and partial pressure of oxygen in brain tissue (PbtO2) and higher cerebral perfusion pressure (CPP) and cerebral hemodynamic param-eters 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 prog-nosis-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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颅内压相关参数和凝血功能对脑外伤患者预后的预测价值。

本研究调查了影响创伤性脑损伤（TBI）患者预后的因素，并评估了颅内压相关参数和凝血功能对预后的预测价值。根据出院时的格拉斯哥结果量表（GOS）评分，将2020年1月至2021年1月期间收治的70例创伤性脑损伤患者分为预后良好组（42例）和预后不良组（28例）。分析了影响预后的因素，并比较了两组患者颅内压和凝血功能的差异。采用接收者操作特征曲线（ROC）计算颅内压相关参数和凝血功能对预后的预测价值。术后 24 小时内，预后良好组的颅内压（ICP）和脑组织氧分压（PbtO2）水平低于预后不良组，脑灌注压（CPP）和脑血流动力学参数高于预后不良组（P<0.05）。预后良好组的凝血酶原时间（PT）、活化部分凝血活酶时间（aPTT）和凝血酶原时间（TT）水平明显低于预后不良组，血小板（PLT）和纤维蛋白原（Fib）水平高于预后不良组（P<0.05）。回归分析显示，CPP、收缩期血流速度（Vs）、舒张末期血流速度（Vd）、平均血流速度（Vm）、PLT、Fib 是预后的独立保护因素，ICP、PbtO2、PT、APTT 和 TT 是预后的危险因素。ROC显示，ICP、CPP、PbtO2、Vs、Vd、Vm、APTT、PLT、Fib对不良预后具有很高的诊断价值（AUC=0.732、0.940、0.796、0.706、0.914、0.729、0.876、0.709、0.866），其中ICP的诊断敏感性最高，Vd的诊断特异性最高。颅内压相关指标和凝血指标是创伤性脑损伤患者的预后相关指标，通过控制颅内压和改善凝血功能可以改善预后和提高生存率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Investigación Clínica

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