Utilization of clinical and radiological parameters to predict cognitive prognosis in patients with mild-to-moderate traumatic brain injury

Xi Wang; Xiaobo Hui; Xiangyu Wang; Baosheng Huang; Xiaokui Gan; Xingdong Liu; Zhiyan Shen; Yi Sun; Lixin Li

doi:10.3389/fnins.2023.1222541

Utilization of clinical and radiological parameters to predict cognitive prognosis in patients with mild-to-moderate traumatic brain injury

Front Neurosci. 2023 Jul 27:17:1222541. doi: 10.3389/fnins.2023.1222541. eCollection 2023.

Authors

Xi Wang^#¹, Xiaobo Hui^#^{1

2}, Xiangyu Wang^#³, Baosheng Huang⁴, Xiaokui Gan⁴, Xingdong Liu¹, Zhiyan Shen¹, Yi Sun¹, Lixin Li¹

Affiliations

¹ Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
² Department of Neurosurgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China.
³ Department of Rehabilitation Medicine, The Affiliated Lianyungang Oriental Hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, China.
⁴ Department of Neurosurgery, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China.

^# Contributed equally.

Abstract

Background: Cognitive impairment is a common sequela following traumatic brain injury (TBI). This study aimed to identify risk factors for cognitive impairment after 3 and 12 months of TBI and to create nomograms to predict them.

Methods: A total of 305 mild-to-moderate TBI patients admitted to the First Affiliated Hospital with Nanjing Medical University from January 2018 to January 2022 were retrospectively recruited. Risk factors for cognitive impairment after 3 and 12 months of TBI were identified by univariable and multivariable logistic regression analyses. Based on these factors, we created two nomograms to predict cognitive impairment after 3 and 12 months of TBI, the discrimination and calibration of which were validated by plotting the receiver operating characteristic (ROC) curve and calibration curve, respectively.

Results: Cognitive impairment was detected in 125/305 and 52/305 mild-to-moderate TBI patients after 3 and 12 months of injury, respectively. Age, the Glasgow Coma Scale (GCS) score, >12 years of education, hyperlipidemia, temporal lobe contusion, traumatic subarachnoid hemorrhage (tSAH), very early rehabilitation (VER), and intensive care unit (ICU) admission were independent risk factors for cognitive impairment after 3 months of mild-to-moderate TBI. Meanwhile, age, GCS score, diabetes mellitus, tSAH, and surgical treatment were independent risk factors for cognitive impairment after 12 months of mild-to-moderate TBI. Two nomograms were created based on the risk factors identified using logistic regression analyses. The areas under the curve (AUCs) of the two nomograms to predict cognitive impairment after 3 and 12 months of mild-to-moderate TBI were 0.852 (95% CI [0.810, 0.895]) and 0.817 (95% CI [0.762, 0.873]), respectively.

Conclusion: Two nomograms are created to predict cognitive impairment after 3 and 12 months of TBI. Age, GCS score, >12 years of education, hyperlipidemia, temporal lobe contusion, tSAH, VER, and ICU admission are independent risk factors for cognitive impairment after 3 months of TBI; meanwhile, age, the GCS scores, diabetes mellitus, tSAH, and surgical treatment are independent risk factors of cognitive impairment after 12 months of TBI. Two nomograms, based on both groups of factors, respectively, show strong discriminative abilities.

Keywords: cognitive impairment; nomogram; predictive factor; radiological parameters; traumatic brain injury.

Grants and funding

This study was supported by grants from the Jiangsu Province Capability Improvement Project through Science, Technology and Education (grant number: ZDXK202225) and the National Natural Science Foundation of China (grant number: 81171147).