Prognostic value of CAR, FIB-4, and procalcitonin in subdural hematoma: associations with mortality and 90-day functional outcomes running title: CAR, FIB-4, and procalcitonin in SDH outcomes

Abstract

Aims: This study aimed to investigate the prognostic value of C-reactive protein/albumin ratio (CAR), Fibrosis-4 (FIB-4) Index, procalcitonin, and hemoglobin, in conjunction with clinical severity scores, for predicting 28-day mortality and 90-day functional outcomes in patients with SDH. Methods: We conducted a retrospective cohort study including 118 adult SDH patients admitted to the intensive care unit of a tertiary university hospital between February 2021 and January 2025. Laboratory parameters (CRP, albumin, procalcitonin, CAR, FIB-4, NLR, PLR, and others) and clinical severity scores (GCS, APACHE II, SOFA) were recorded within the first 24 hours of admission. Primary outcomes were 28-day mortality and 90-day functional status assessed with the modified rankin scale (mRS), dichotomized as favorable (0-2) or poor (≥3). Results: The 28-day mortality rate was 19.5%, and poor 90-day functional outcome was observed in 54.2% of patients. Advanced age, elevated CAR, FIB-4, and procalcitonin levels, along with low albumin and hemoglobin levels, were significantly associated with poor outcomes (all p<0.05). Logistic regression identified age (OR=1.04, p=0.017), procalcitonin (OR=3.99, p=0.010), and hemoglobin (OR=0.73, p=0.013) as independent predictors of 28-day mortality. For 90-day outcomes, age (OR=1.06, p<0.001), albumin (OR=0.84, p<0.001), CRP (OR=1.02, p=0.001), and hemoglobin (OR=0.75, p=0.004) emerged as significant predictors. NLR and PLR were not prognostic. Conclusion: Early measurement of CAR, FIB-4, procalcitonin, and hemoglobin provides clinically meaningful prognostic value for both short-term mortality and long-term functional outcomes in SDH patients. Integrating these biomarkers with clinical scoring systems may enhance individualized risk stratification and guide early management strategies.

Keywords

• Subdural hematoma
• CAR
• FIB-4
• procalcitonin
• hemoglobin
• prognosis
• Modified Rankin Scale

Supporting Institution

Giresun University School of Medicine

Ethical Statement

The study protocol was approved by the Giresun Training and Research Hospital Ethics Committee (Date:25.06.2025, Decision No: 25.06.2025/18).

Subdural hematomda CAR, FIB-4 ve prokalsitonin’in prognostik değeri: 28. gün mortalitesi ve 90. gün fonksiyonel sonuçlarla ilişkisi

Abstract

Amaç: Bu çalışmanın amacı, C-reaktif protein/albümin oranı (CAR), Fibrozis-4 (FIB-4) indeksi, prokalsitonin ve hemoglobinin, klinik şiddet skorları ile birlikte değerlendirilerek subdural hematom (SDH) hastalarında 28. gün mortalitesi ve 90. gün fonksiyonel sonuçlarını öngörmedeki prognostik değerini araştırmaktır. Yöntemler: Şubat 2021 – Ocak 2025 tarihleri arasında üçüncü basamak bir üniversite hastanesi yoğun bakım ünitesine kabul edilen 118 erişkin SDH hastası retrospektif olarak incelendi. Hastaların ilk 24 saatinde ölçülen laboratuvar parametreleri (CRP, albümin, prokalsitonin, CAR, FIB-4, NLR, PLR ve diğerleri) ve klinik şiddet skorları (GKS, APACHE II, SOFA) kaydedildi. Birincil sonuç ölçütleri, 28. gün mortalitesi ve 90. gün fonksiyonel durumu idi. Fonksiyonel durum modifiye Rankin Skalası (mRS) ile değerlendirildi ve iyi prognoz (0–2) ile kötü prognoz (≥3) olarak sınıflandırıldı. Bulgular: Yirmi sekizinci gün mortalite oranı %19,5, 90. günde kötü fonksiyonel sonuç oranı ise %54,2 bulundu. İleri yaş, yüksek CAR, FIB-4 ve prokalsitonin düzeyleri ile düşük albümin ve hemoglobin düzeyleri kötü prognoz ile anlamlı ilişkiliydi (tümü p<0,05). Lojistik regresyon analizinde, 28. gün mortalitesi için yaş (OR=1,04, p=0,017), prokalsitonin (OR=3,99, p=0,010) ve hemoglobin (OR=0,73, p=0,013) bağımsız belirleyiciler olarak saptandı. Doksanıncı gün fonksiyonel sonuçlar için ise yaş (OR=1,06, p<0,001), albümin (OR=0,84, p<0,001), CRP (OR=1,02, p=0,001) ve hemoglobin (OR=0,75, p=0,004) anlamlı prediktörlerdi. NLR ve PLR prognostik değer göstermedi. Sonuç: SDH hastalarında erken dönemde ölçülen CAR, FIB-4, prokalsitonin ve hemoglobin düzeyleri, hem kısa dönem mortalite hem de uzun dönem fonksiyonel sonuçlar için klinik açıdan anlamlı prognostik değer sunmaktadır. Bu biyobelirteçlerin klinik skorlama sistemleri ile entegrasyonu, bireyselleştirilmiş risk katmanlamasını güçlendirebilir ve erken yönetim stratejilerine rehberlik edebilir.

Keywords

• Subdural hematom
• CAR
• FIB-4
• prokalsitonin
• hemoglobin
• prognoz
• modifiye Rankin Skalası.

Supporting Institution

Giresun Üniversitesi Tıp Fakültesi

Ethical Statement

Çalışma, Giresun Eğitim ve Araştırma Hastanesi Etik Kurulu tarafından onaylandı (Tarih: 25.06.2025, Karar No: 25.06.2025/18).

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