Prediction of Initial CRP/Albumin Ratio on In-Hospital Mortality in Isolated Traumatic Brain Injury Patients
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Data Collection
2.3. Treatment Regimen and Intensive Care Unit Treatment
2.4. Cardiopulmonary Parameters
2.5. Serum Biomarkers
2.6. Radiological Data
2.7. In-Hospital Outcome and Mortality
2.8. Statistical Analysis
3. Results
3.1. Main Characteristics
3.2. In-Hospital Mortality and Outcome
4. Discussion
4.1. In-Hospital Mortality
4.2. C-Reactive Protein/Albumin Ratio
4.3. Limitations of the Study
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Parameter | Results |
---|---|
Baseline data | |
Age, years, mean (±SD) * | 66.3 (19.9) |
Women, n (%) * | 75 (37.5) |
Men, n (%) * | 125 (62.5) |
Body mass index, kg/m2, mean (±SD) * | 26.0 (4.1) |
Glasgow coma scale score, median (IQR) * | 11 (3–15) |
AIS score, median (IQR) * | 0 (0–0) |
AIS score 0, n (%) * | 160 (80.0) |
AIS score 1, n (%) * | 40 (20.0) |
AIS head score, median (IQR) * | 2 (1–5) |
AIS head score 1, n (%) * | 52 (26.0) |
AIS head score 2, n (%) * | 55 (27.5) |
AIS head score 3, n (%) * | 7 (3.5) |
AIS head score 4, n (%) * | 22 (11.0) |
AIS head score 5, n (%) * | 31 (15.5) |
AIS head score 6, n (%) * | 33 (16.5) |
APACHE II score, median (IQR) * | 14 (9–21) |
Comorbidities, n (%) * | 130 (65.0) |
Premedication, n (%) * | 124 (62.0) |
Emergency surgery, n (%) *** | 79 (39.5) |
Intubation, n (%) ** | 97 (48.5) |
Tracheostomy, n (%) *** | 20 (10.0) |
Aspiration, n (%) *** | 54 (27.0) |
Cardiopulmonary parameters | |
Norepinephrine application rate, µg/kg/min, median (IQR) ** | 0.06 (0–0.04) |
Systolic blood pressure, mmHg, median (IQR) ** | 128 (118–138) |
Mean arterial pressure, mmHg, median (IQR) ** | 81 (74–90) |
Heart rate, beats per minute, median (IQR) ** | 75.5 (67.8–87.3) |
Respiration rate, n per minute, median (IQR) ** | 12 (12–17) |
Inspiratory oxygen fraction, %, median (IQR) ** | 40.0 (21–40) |
PEEP level, median (IQR) ** | 6 (5–7) |
Body temperature, centigrade, median (IQR) * | 36.7 (36.2–37.3) |
Biomarkers | |
White blood cells, giga/L, median (IQR) ** | 11.8 (11.4–14.7) |
Hemoglobin, g/dL, median (IQR) ** | 13.0 (11.4–14.5) |
Hematocrit, l/L, median (IQR) ** | 0.38 (0.34–0.42) |
Thrombocytes, giga/L, median (IQR) ** | 181.5 (155–261) |
Prothrombin time, %, median (IQR) ** | 83.5 (70.5–101) |
Partial thromboplastin time, sec, median (IQR) ** | 27.5 (26–33) |
Fibrinogen, g/L, median (IQR) ** | 2.55 (2.31–3.35) |
Antithrombin 3, %, median (IQR) ** | 85.5 (75.3–97.8) |
Sodium, mmol/L, median (IQR) ** | 139 (137–141) |
Potassium, mmol/L, median (IQR) ** | 3.9 (3.6–4.2) |
Creatinine, mg/dL, median (IQR) ** | 0.8 (0.6–1.1) |
Urea, mg/dL, median (IQR) ** | 28 (25.3–47.8) |
Cholinesterase, U/L, median (IQR) ** | 7246 (5378–9255) |
Blood glucose, mg/dL, median (IQR) ** | 134.5 (112–163) |
Serum lactate, mmol/L, median (IQR) ** | 1.5 (1.0–2.3) |
Troponin I, ng/mL, median (IQR) ** | 0.01 (0.01–0.04) |
Cortisol, µg/dL, median (IQR) ** | 23.2 (16.6–36.6) |
C-reactive protein, mg/dL, median (IQR) ** | 2.25 (1.1–20.7) |
Albumin, g/L, median (IQR) ** | 37.5 (35.1–43.1) |
C-reactive protein/Albumin ratio, median (IQR) ** | 0.067 (0.026–0.533) |
Radiological data | |
Subdural hematoma, n (%) * | 41 (20.5) |
Epidural hematoma, n (%) * | 5 (2.5) |
Traumatic subarachnoid hemorrhage, n (%) * | 11 (5.5) |
Brain contusion, n (%) * | 6 (3) |
Diffuse axonal injury, n (%) * | 3 (1.5) |
Skull fracture, n (%) * | 1 (0.5) |
Diffuse traumatic brain injury, n (%) * | 133 (66.5) |
Outcome | |
mRS score, median (IQR) **** | 3 (0–6) |
mRS 0, n (%) **** | 68 (34) |
mRS 1, n (%) **** | 13 (56.5) |
mRS 2, n (%) **** | 8 (4) |
mRS 3, n (%) **** | 18 (9) |
mRS 4, n (%) **** | 11 (5.5) |
mRS 5, n (%) **** | 27 (13.5) |
mRS 6, n (%) **** | 55 (27.5) |
GOS score, median (IQR) **** | 4 (1–5) |
GOS 1, n (%) **** | 55 (27.5) |
GOS 2, n (%) **** | 13 (6.5) |
GOS 3, n (%) **** | 25 (12.5) |
GOS 4, n (%) **** | 27 (13.5) |
GOS 5, n (%) **** | 80 (40) |
GCS | Survivor | Non-Survivor | IHM [%] |
---|---|---|---|
3 | 23 | 32 | 58.18 |
4 | 1 | 1 | 50 |
5 | 5 | 2 | 28.57 |
6 | 2 | 0 | 0 |
7 | 3 | 3 | 50 |
8 | 5 | 4 | 44.44 |
9 | 0 | 0 | - |
10 | 8 | 1 | 11.11 |
11 | 10 | 2 | 16.67 |
12 | 10 | 2 | 16.67 |
13 | 10 | 4 | 28.57 |
14 | 20 | 1 | 4.76 |
15 | 48 | 3 | 5.88 |
Parameter | Survivor (n = 145) | Non-Survivor (n = 55) | p-Value |
---|---|---|---|
Baseline Data | |||
Age, years, mean (±SD) * | 63.5 (20.9) | 73.6 (14.5) | 0.002 |
Women, n (%) * | 55 (37.9) | 20 (36.4) | 0.838 |
Men, n (%) * | 90 (62.1) | 35 (63.6) | |
Body mass index, kg/m2, mean (±SD) * | 25.9 (3.7) | 26.3 (4.9) | 0.397 |
Glasgow coma scale score, median (IQR) * | 13 (8–15) | 3 (3–8) | <0.0001 |
AIS score, median (IQR) * | 0 (0–0) | 0 (0–1) | 0.113 |
AIS score 0, n (%) * | 120 (82.8) | 40 (72.7) | |
AIS score 1, n (%) * | 25 (17.2) | 15 (27.3) | |
AIS head score, median (IQR) * | 2 (1–3) | 6 (5–6) | <0.0001 |
AIS head score 1, n (%) * | 52 (35.9) | 0 (0) | |
AIS head score 2, n (%) * | 55 (37.9) | 0 (0) | |
AIS head score 3, n (%) * | 7 (4.8) | 0 (0) | |
AIS head score 4, n (%) * | 9 (6.2) | 13 (23.6) | |
AIS head score 5, n (%) * | 22 (15.2) | 9 (16.4) | |
AIS head score 6, n (%) * | 0 (0) | 33 (60.0) | |
APACHE II score, median (IQR) * | 11 (8–17) | 21.5 (18–26.3) | <0.0001 |
Comorbidities, n (%) * | 91 (62.8) | 39 (70.9) | 0.407 |
Premedication, n (%) * | 91 (62.8) | 33 (60) | 0.130 |
Emergency surgery, n (%) *** | 53 (36.6) | 26 (47.3) | 0.006 |
Intubation, n (%) ** | 49 (33.8) | 48 (87.3) | <0.0001 |
Tracheostomy, n (%) *** | 19 (13.1) | 1 (1.8) | 0.018 |
Aspiration, n (%) *** | 35 (24.1) | 19 (34.5) | 0.256 |
Cardiopulmonary parameter | |||
Norepinephrine application rate, µg/kg/min, median (IQR) ** | 0.0 (0.0–0.03) | 0.03 (0.00–0.01) | <0.0001 |
Mean arterial pressure, mmHg, median (IQR) ** | 82 (74–90) | 78.5 (67.3–91.5) | 0.126 |
Heart rate, beats per minute, median (IQR) ** | 76 (68–87) | 72 (63–88.5) | 0.246 |
Respiration rate, n per minute, median (IQR) ** | 15 (12–17) | 12 (10–15) | <0.0001 |
Inspiratory oxygen fraction, %, median (IQR) ** | 21 (21–40) | 35 (21–45) | 0.002 |
PEEP level, median (IQR) ** | 5.5 (5–7) | 5 (5–6) | 0.089 |
Body temperature, centigrade, median (IQR) * | 36.9 (36.4–37.3) | 36.3 (35.1–36.8) | <0.0001 |
Biomarkers | |||
White blood cells, giga/L, median (IQR) ** | 10.0 (7.4–14.3) | 11.9 (9.8–15.7) | 0.005 |
Hemoglobin, g/dL, median (IQR) ** | 13.5 (11.9–14.8) | 12.2 (10–13.8) | 0.001 |
Hematocrit, l/L, median (IQR) ** | 0.39 (0.35–0.43) | 0.36 (0.3–0.4) | 0.002 |
Thrombocytes, giga/L, median (IQR) ** | 209 (160–272.5) | 193 (144–251) | 0.130 |
Prothrombin time, %, median (IQR) ** | 94 (80–102) | 82 (56–96) | 0.002 |
Partial thromboplastin time, sec, median (IQR) ** | 28 (26–31) | 31 (27–39) | <0.0001 |
Fibrinogen, g/L, median (IQR) ** | 2.77 (2.32–3.33) | 2.72 (2.22–3.46) | 0.793 |
Antithrombin 3, %, median (IQR) ** | 89 (77.3–97.8) | 284 (71.5–98.3) | 0.364 |
Creatinine, mg/dL, median (IQR) ** | 0.8 (0.6–1) | 0.9 (0.7–1.3) | 0.087 |
Urea, mg/dL, median (IQR) ** | 34 (24.5–46) | 42 (28–59) | 0.011 |
Cholinesterase, U/L, median (IQR) ** | 7711.5 (5757.5–9332) | 6555 (3863–8942) | 0.031 |
Blood glucose, mg/dL, median (IQR) ** | 123 (110–154) | 158 (131–182) | <0.0001 |
Serum lactate, mmol/L, median (IQR) ** | 1.3 (0.9–2.1) | 2.1 (1.2–3.2) | <0.0001 |
Troponin I, ng/mL, median (IQR) ** | 0.01 (0.01–0.02) | 0.02 (0.01–0.08) | 0.009 |
Cortisol, µg/dL, median (IQR) ** | 24.4 (16.4–35.9) | 28 (17.6–45) | 0.250 |
C-reactive protein, mg/dL, median (IQR) ** | 4.01 (0.88–19.47) | 8.1 (1.6–24) | 0.169 |
Albumin, g/L, median (IQR) ** | 39.5 (36.5–43.7) | 36.4 (32.6–41.1) | <0.0001 |
C-reactive protein/Albumin ratio, median (IQR) ** | 0.09 (0.02–0.48) | 0.24 (0.04–0.68) | 0.038 |
Radiological data | |||
Localization | 0.158 | ||
Subdural hematoma, n (%) * | 27 (18.6) | 14 (25.5) | |
Epidural hematoma, n (%) * | 5 (3.4) | 0 (0) | |
Traumatic subarachnoid hemorrhage, n (%) * | 11 (7.6) | 0 (0) | |
Brain contusion, n (%) * | 5 (3.4) | 1 (1.8) | |
Diffuse axonal injury, n (%) * | 3 (2.1) | 0 (0) | |
Skull fracture, n (%) * | 1 (0.7) | 0 (0) | |
Diffuse traumatic brain injury, n (%) * | 93 (64.1) | 40 (72.7) |
Parameter | Odds Ratio | 95% CI | p-Value |
---|---|---|---|
Age, years, mean (±SD) * | 0.953 | 0.927–0.981 | 0.001 |
Glasgow coma scale score, median (IQR) * | 1.347 | 1.203–1.509 | <0.0001 |
Norepinephrine application rate, µg/kg/min, mean (±SD) ** | 0.000 | 0.000–0.090 | 0.016 |
Serum lactate, mmol/L, median (IQR) ** | 0.506 | 0.353–0.725 | <0.0001 |
Inspiratory oxygen fraction, mean (±SD) ** | 1.041 | 0.995–1.088 | 0.079 |
C-reactive protein/Albumin ratio, mean (±SD) * | 0.547 | 0.316–0.945 | 0.031 |
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Friedrich, M.; Haferkorn, K.; Stein, M.; Uhl, E.; Bender, M. Prediction of Initial CRP/Albumin Ratio on In-Hospital Mortality in Isolated Traumatic Brain Injury Patients. Biomedicines 2024, 12, 1084. https://doi.org/10.3390/biomedicines12051084
Friedrich M, Haferkorn K, Stein M, Uhl E, Bender M. Prediction of Initial CRP/Albumin Ratio on In-Hospital Mortality in Isolated Traumatic Brain Injury Patients. Biomedicines. 2024; 12(5):1084. https://doi.org/10.3390/biomedicines12051084
Chicago/Turabian StyleFriedrich, Michaela, Kristin Haferkorn, Marco Stein, Eberhard Uhl, and Michael Bender. 2024. "Prediction of Initial CRP/Albumin Ratio on In-Hospital Mortality in Isolated Traumatic Brain Injury Patients" Biomedicines 12, no. 5: 1084. https://doi.org/10.3390/biomedicines12051084