Prognostic value of admission laboratory parameters in traumatic brain injury: results from the IMPACT study.
Abnormalities in laboratory parameters are frequent following traumatic brain injury (TBI), but few studies have investigated their predictive value. We aimed to describe and quantify the relation between laboratory parameters that are routinely determined on admission and final outcome following TBI. Individual patient data were available in the IMPACT database from six Phase III randomized controlled trials and one observational study in TBI. We studied glucose (N = 4834), sodium ( N = 5270), pH ( N = 3398), hemoglobin (Hb, N = 3875), platelet count ( N = 1629), and prothrombin time (PT; N = 840) for their associations with outcome at 6 months (Glasgow Outcome Scale [GOS]). We used logistic regression models with linear, quadratic, and restricted cubic spline functions. The strength of the associations was expressed as an unadjusted odds ratio, calculated over the shift in outcome between the 25th and 75th percentiles. Proportional odds methodology was further applied to quantify the strength of the associations across the full range of the GOS. All parameters were consistently associated with outcome in a continuous relationship: glucose and prothrombin time showed a positive linear relation to outcome (i.e., increasing values associated with poorer outcome) and Hb, platelets, and pH an inverse linear relation (i.e., low values associated with poorer outcome). Sodium demonstrated a U-shaped relation to outcome, with low levels being more strongly related to poorer outcome. Effects were strongest for increasing levels of glucose (odds ratio 1.7; 95% CI 1.54-1.83) and decreasing levels of Hb (odds ratio 0.7; CI 0.60-0.78). Higher glucose values were associated with increasing age, but on adjusted analysis, the strength of the association with outcome remained. Whether treatment of abnormal values may improve outcome needs further rigorous study.
Van Beek
Jackelien G M
JG
Center for Clinical Decision Making, Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
Mushkudiani
Nino A
NA
Steyerberg
Ewout W
EW
Butcher
Isabella
I
McHugh
Gillian S
GS
Lu
Juan
J
Marmarou
Anthony
A
Murray
Gordon D
GD
Maas
Andrew I R
AI
D001786:Blood Glucose / Q000378:metabolism; D001930:Brain Injuries / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D016208:Databases, Factual; D003955:Diagnostic Tests, Routine; D023261:Glasgow Outcome Scale; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D006863:Hydrogen-Ion Concentration; D010976:Platelet Count; D011237:Predictive Value of Tests; D011379:Prognosis; D011517:Prothrombin Time; D012964:Sodium / Q000097:blood
D001786:Blood Glucose; D006454:Hemoglobins; D012964:Sodium