Biochemical and Radiological Factors for Prognostication of Traumatic Brain Injury: An Institutional Experience

Abinav Sivashankar S; Sai Sriram Swamiyappan; Vivek Visweswaran; Rav Tej Bathala; Visvanathan Krishnaswamy; Venkata Shashank Davuluri; Ashwin Sridhar; Ganesh K

doi:10.7759/cureus.40999

Biochemical and Radiological Factors for Prognostication of Traumatic Brain Injury: An Institutional Experience

Cureus. 2023 Jun 26;15(6):e40999. doi: 10.7759/cureus.40999. eCollection 2023 Jun.

Authors

Abinav Sivashankar S¹, Sai Sriram Swamiyappan², Vivek Visweswaran¹, Rav Tej Bathala², Visvanathan Krishnaswamy², Venkata Shashank Davuluri¹, Ashwin Sridhar¹, Ganesh K¹

Affiliations

¹ Neurological Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND.
² Neurosurgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND.

Abstract

Introduction Traumatic brain injury (TBI) necessitates identifying patients at risk of fatal outcomes. Classic biomarkers used clinically today in other organ systems are quantitative in nature. This aspect largely restricts the prognostic ability of a theoretical quantitative brain biomarker. This study aimed to explore biochemical markers and imaging findings reflecting the severity of cerebral damage to predict outcomes. Methodology In this study, 61 TBI cases with moderate to severe brain injury were prospectively observed, and various indices including random blood sugar (RBS), hemoglobin, international normalized ratio (INR), lactate dehydrogenase (LDH), cortisol, and CT findings were assessed. Glasgow Outcome Scores (GOS) determined the outcomes. Statistical analysis was carried out to assess correlations. Results The mean RBS level of those who did not survive was 259.58 mg/dL, whereas in those who survived the value was 158.48 mg/dL. Analysis indicated that patients with high RBS value on admission had a higher risk of mortality (p=0.000). We noted that the mean serum cortisol levesl on both Days 1 and 5 were higher in patients who died and were able to establish a statistically significant correlation between both the values and outcome. A statistically significant negative correlation between Day 1 and Day 5 serum LDH levels and outcomes was evident from our study (p=0.000 for both). Among the components of the Rotterdam score, the presence of intraventricular hemorrhage (IVH) in the CT scan had a significant association with unfavorable outcomes (p=0.01) while midline shift was significantly associated with a low GCS (p=0.04). Conclusion Biochemical markers such as INR, RBS, serum cortisol, and LDH at admission can serve as valuable indicators of prognosis in TBI patients. Furthermore, a persistent increase in LDH and cortisol levels between Days 1 and 5, along with the Glasgow Coma Scale and Rotterdam Scoring system, are good predictors of mortality.

Keywords: brain ct scan; gcs (glasgow coma score ); lactate dehydrogenase (ldh); serum cortisol; traumatic brain injury.