Background:Initial management of severe traumatic brain injury (TBI) is important, and includes treatment decision-making and prediction of prognosis. We examined whether biomarkers at admission could be useful prognostic predictors. We focused on electrolytes and blood glucose, which can be measured easily at any facility and for which the results can be obtained promptly before those of other biomarkers, such as D-dimer.
Methods:All trauma patients with head injury treated at Chiba Hokusoh Hospital between 2014 and 2017 were investigated. Multiple trauma cases accompanied by fatal trauma, hemorrhagic shock, and cardiopulmonary arrest, and pediatric cases were excluded from this study. The blood gas data at the initial hospital visit were reviewed retrospectively. Cases in which the patients died or were in a vegetative state due to a head injury during hospitalization were defined as having a poor outcome. Factors related to poor outcome were analyzed.
Results:Of 185 male and 79 female patients enrolled in the study, 34 had a poor outcome. Poor outcome was correlated significantly with potassium (P = 0.003), glucose (P < 0.001), and the glucose-to-potassium ratio (P < 0.001) at arrival. In particular, the odds ratio for a glucose-to-potassium ratio of ≥50 was 4.079.
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Conclusions:We evaluated blood gas data at initial hospital visit as these results can be obtained more quickly than those of other biomarkers assessed previously. Serum glucose-to-potassium ratio at admission may be a potential predictor of prognosis for severe TBI.