Multivariate outcome prediction in traumatic brain injury with focus on laboratory values

• Traumatic brain injury (TBI) is a major cause of morbidity and mortality. Identifying factors relevant to outcome can provide a better understanding of TBI pathophysiology, in addition to aiding prognostication. Many common laboratory variables have been related to outcome but may not be independent predictors in a multivariate setting. In this study, 757 patients were identified in the Karolinska TBI database who had retrievable early laboratory variables. These were analyzed towards a dichotomized Glasgow Outcome Scale (GOS) with logistic regression and relevance vector machines, a non-linear machine learning method, univariately and controlled for the known important predictors in TBI outcome: age, Glasgow Coma Score (GCS), pupil response, and computed tomography (CT) score. Accuracy was assessed with Nagelkerke's pseudo R2. Of the 18 investigated laboratory variables, 15 were found significant (p<0.05) towards outcome in univariate analyses. In contrast, when adjusting for other predictors, few remained significant. Creatinine was found an independent predictor of TBI outcome. Glucose, albumin, and osmolarity levels were also identified as predictors, depending on analysis method. A worse outcome related to increasing osmolarity may warrant further study. Importantly, hemoglobin was not found significant when adjusted for post-resuscitation GCS as opposed to an admission GCS, and timing of GCS can thus have a major impact on conclusions. In total, laboratory variables added an additional 1.3-4.4% to pseudo R2.

Nyckelord

Glasgow Coma Score

Glasgow Outcome Scale

hematologic tests

outcome

traumatic brain injury (TBI)

albumin

creatinine

glucose

adolescent

article

computer assisted tomography

female

human

laboratory test

machine learning

major clinical study

male

osmolarity

outcome assessment

predictor variable

pupil reflex

traumatic brain injury

Adult

Age Factors

Aged

Aged

80 and over

Biological Markers

Blood Chemical Analysis

Brain Injuries

Glasgow Coma Scale

Humans

Linear Models

Logistic Models

Middle Aged

Multivariate Analysis

Nonlinear Dynamics

Predictive Value of Tests

Prognosis

Sex Factors

Treatment Outcome

Young Adult

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)