“Biomarkers in the Prediction of Prognosis in Traumatic Head Injury Patients at Our Tertiary Care Hospital”: A Prospective Follow-up Study

Abstract

Abstract Introduction: Traumatic brain injury occurs when a sudden trauma, often a blow of jolt to the head causes damage to brain. The severity Traumatic brain injury is the leading cause of morbidity and mortality across the globe from developing to developed nations. There is increase in the inflammation reaction in Head injury/Traumatic brain injury patients evidenced by raise in the inflammatory cytokines, chemokines and acute phase reactants in serum as well in cerebrospinal fluid (CSF). Measuring these acute phase reactants in the blood sample will aid in understanding the progression of pathogenesis resulting from TBI thus the prognosis and outcomes can be predicted. Objectives of the study: to determine the levels of acute phase reactants (albumin, CRP, Prothrombin, ESR, thrombocytes, fibrinogen, transferrin) within 24 hours of admission and to find out the correlation of baseline values of Acute Phase Reactants with respect to mortality and clinical outcomes at admission and follow-ups. Methodology: At the time of admission the severity of head injury/traumatic brain injury was assessed using Glasgow Coma Scale (GCS). All the patients underwent detailed clinical evaluation including GCS score, based on GCS score they were categorized as mild, moderate and severe traumatic brain injury. Subsequent relevant laboratory investigations were carried out which include acute phase reactant biomarkers albumin, c reactive protein (CRP), prothrombin, fibrinogen and transferrin levels along with routine laboratory investigations (hemoglobin, complete hemogram, arterial blood gas analysis) within 24 hours of day of admission. GOS scoring was done in all the patients at the time of discharge and follow-ups at one month and third month. Statistical analysis: Categorically data was presented as frequency and percentage (%), and measurement data with normal distribution were presented as mean ± S.D. The independent predictors of head injury were determined by univariate and multivariate logistic regression analysis odds ratio (OR) and 95% of confidence of interval (CI) was calculated. Conclusion: In our study we found that, the head injury patients had decreased albumin level and transferrin level while the levels CRP, prothrombin, ESR, thrombocytes and plasma fibrinogen were increased at the time of admission. Most of the patients had severe GCS score at the time of admission. All the acute phase reactants (serum albumin, CRP, prothrombin, ESR, thrombocytes, plasma fibrinogen and transferrin) had highly significant association with the severity of head injury (GCS score) at the time of admission. The association between severity of head injury (according to GCS score) at the time of admission and severity of head injury (according to GCS score) at the time of discharge and after one month of discharge are highly significant. In the present study we conclude that levels of plasma fibrinogen, serum transferrin and GCS score at the time of admission had statistically highly significant impact on the outcomes of head injury patients at the time of discharge, one month follow-up, and three months follow-ups respectively. Thus, measurement of these biomarkers at the time of admission in patients with head injury will be highly helpful in predicting the prognosis. Further, our Research study also adds the significant values for future planning of usage of anti-inflammatory drugs to manage head injury patients for the better outcome.