Systemic inflammatory biomarkers for predicting clinical deterioration in traumatic brain injury

Abstract

Background: Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. Identifying patients at risk of early clinical deterioration is essential for timely intervention.

Methods: We retrospectively analyzed adult patients with mild to moderate TBI admitted to a tertiary care center. Three biomarkers were calculated from admission labs: red cell distribution width-to-platelet ratio (RPR), C-reactive protein-to-albumin ratio (CAR), and neutrophil-to-lymphocyte ratio × RPR (NLTRP). The primary outcome was deterioration within 5 days, defined as a ≥2-point decline in Glasgow Coma Scale or need for mechanical ventilation. The secondary outcome was 28-day mortality.

Results: Of 378 patients, 67 (17.7%) deteriorated and 30 (10.3%) died within 28 days. RPR (AUC 0.614, p=0.003) and CAR (AUC 0.609, p=0.005) predicted early deterioration. RPR (AUC 0.719, p<0.001), CAR (AUC 0.650, p=0.006), and NLTRP (AUC 0.645, p=0.008) predicted mortality. In multivariate analysis, CAR independently predicted early deterioration (OR 1.715, 95% CI 1.310–2.246).

Conclusion: RPR, CAR, and NLTRP are inexpensive, routinely available markers that may assist in early risk stratification of mild to moderate TBI. Validation in prospective multicenter studies is warranted.