Prognostic Value of Serum Procalcitonin Based Model in Moderate to Severe Traumatic Brain Injury Patients

Abstract

Ruoran Wang,1,* Yusi Hua,2,* Min He,3 Jianguo Xu1 1Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 2Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 3Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jianguo Xu, Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, People’s Republic of China, Email [email protected] Min He, Department of Critical Care Medicine, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, People’s Republic of China, Email [email protected]: Procalcitonin (PCT) is an acknowledged marker of systemic inflammatory response. Previous studies have not reached agreement on the association between serum PCT and outcome of traumatic brain injury (TBI) patients. We designed this study to confirm the prognostic value of PCT in isolated TBI and those with extracranial injury, respectively.Methods: Patients hospitalized in our hospital for moderate-to-severe TBI between March 2015 and December 2019 were included. Logistic regression analysis was performed to validate the association between PCT and in-hospital mortality in these patients. AUC (area under the receiver operating characteristics curve) of PCT and constructed model were calculated and compared.Results: Among the included 211 patients, 81 patients suffered a poor outcome, with a mortality rate of 38.4%. Non-survivors had a higher level of serum PCT (2.73 vs 0.72, p< 0.001) and lower GCS (5 vs 7, p< 0.001) on admission than survivors. AUC of single PCT for predicting mortality in isolated TBI and those with extracranial injury were 0.767 and 0.553, respectively. Multivariate logistic regression showed that GCS (OR=0.744, p=0.008), glucose (OR=1.236, p< 0.001), cholesterol (OR=0.526, p=0.002), and PCT (OR=1.107, p=0.022) were independently associated with mortality of isolated TBI. The AUC of the prognostic model composed of GCS, glucose, cholesterol, and PCT was 0.868 in isolated TBI.Conclusion: PCT is an efficient marker of outcome in isolated moderate-to-severe TBI but not those with extracranial injury. A prognostic model incorporating PCT is useful for clinicians to make early risk stratification for isolated TBI.Keywords: procalcitonin, traumatic brain injury, extracranial injury, prognosis

Keywords

• procalcitonin
• traumatic brain injury
• extracranial injury
• prognosis