Glasgow Coma Scale–Pupils Score and C-Reactive Protein-to-Albumin Ratio as Predictors of In-hospital Mortality in Moderate-to-Severe Traumatic Brain Injury

Öz

Aim: Traumatic brain injury (TBI) is a vital disease entity associated with high mortality and neurological sequelae. This study seeks to evaluate the prognostic role of the Glasgow Coma Scale–Pupil score (GCS-P) and the C-reactive protein-to-albumin ratio (CAR) on mortality in patients with moderate and severe TBI. Methods: In this retrospective observational study, patients with moderate to severe TBI who were admitted to and managed in the intensive care unit (ICU) between January 2021 and June 2023 were included. The patients were classified into survivors and non-survivors. Demographic and clinical characteristics, Glasgow Coma Scale (GCS), GCS-P, and CAR were recorded. CAR was calculated by dividing the C-reactive protein (CRP) level by the albumin level obtained from routine blood tests at admission. Results: The study cohort consisted of 177 patients, with an in-hospital mortality rate of 22%. In the non-survivors, GCS and GCS-P scores were significantly lower, whereas CAR was significantly higher (all p < 0.001). In the multivariable analysis, GCS-P (odds ratio=0.425, p=0.028) and CAR (odds ratio=1.275, p=0.022) were identified as independent predictors of mortality. For the prediction of mortality, the cut-off value for GCS-P was 4.5 with an area under the curve (AUC) of 0.863, while the cut-off value for CAR was 0.07 with an AUC of 0.721. Conclusion: In patients with moderate to severe TBI admitted to the ICU, the GCS-P score and CAR are independent predictors of in-hospital mortality. The combined use of GCS-P, reflecting neurological status, and CAR, reflecting systemic inflammation and nutritional status, may provide additional prognostic value.

Anahtar Kelimeler

• Traumatic brain injury
• Glasgow coma scale pupil score
• Glasgow coma scale
• C-reactive protein-to-albumin ratio
• mortality

Destekleyen Kurum

None.

Etik Beyan

This single-center retrospective observational study was approved by the Institutional Review Board at University of Health Sciences, Istanbul Kanuni Sultan Süleyman Training and Research Hospital (approval number: KAEK/2025.08.191) and the need for written informed consent was waived.

Teşekkür

None.

Glasgow Koma Skalası-Pupil Skoru ve C-Reaktif Proteinin Albumine Oranının Orta ve Şiddetli Travmatik Beyin Hasarında Hastane İçi Ölümü Öngörmedeki Rolü

Öz

Amaç: Travmatik beyin hasarı (TBH), yüksek mortalite ve nörolojik sekellerle seyreden önemli bir hastalık grubudur. Bu çalışmanın amacı, orta ve ciddi TBH’li hastalarda Glasgow Koma Skala Pupil Skoru (GKS-P) ile C-reaktif protein/albümin (CAR) oranının mortalite üzerine prognostik rolünü araştırmaktır. Yöntem: Bu retrospektif gözlemsel çalışmaya, Ocak 2021–Haziran 2023 tarihleri arasında yoğun bakım ünitesinde (YBÜ) takip ve tedavisi gerekleştirilen orta-ciddi TBH’li hastalar dahil edildi. Hastalar yaşayanlar ve ölenler olarak sınıflandıırldı. Hastaların demografik ve klinik özellikleri, Glasgow Koma Skalası (GKS), GKS-P ile CAR oranı kaydedildi. CAR, kabuldeki rutin kan sonuçlarından CRP ve albümin seviyesinin bölünmesi ile hesaplandı. Bulgular: Çalışmaya toplam 177 hasta dahil edildi ve hastane içi mortalite oranı %22 saptandı. Yaşamayan grupta GKS ve GKS-P skorları anlamlı olarak düşük, CAR ise anlamlı olarak yüksek bulundu (tümü için p<0.001). Çok değişkenli analizde GKS-P (odds ratio= 0.425, p=0.028) ile CAR (odds ratio=1.275, p=0.022) mortalitenin bağımsız prediktörleri saptandı. Mortalite öngörüsünde GKS-P’nin kesme değeri 4.5, eğri altındaki alan 0.863, CAR’ın kesme değeri 0.07 ve eğri altındaki alan 0.721 saptandı. Sonuç: YBÜ’de takipli orta-ciddi TBH’li hastalarda GKS-P skoru ve CAR hastane içi mortalitenin bağımsız prediktörleridir. Nörolojik değerlendirmeyi yansıtan GKS-P ile sistemik inflamasyon ve beslenme durumunu gösteren CAR’ın birlikte kullanımı prognostik değer taşıyabilir.

Anahtar Kelimeler

• Travmatik beyin hasarı
• Glasgow koma skala pupil skor
• Glasgow koma skalası
• C-reaktif protein/albumin oranı
• Mortalite

Kaynakça

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