Predictors of adverse outcomes after severe traumatic brain injury

Brain injury is accompanied not only by primary neurological disorders, but also secondary complications, including organ dysfunction, immunosuppression with infections and disorders of homeostasis. One way or another, all of them are associated with cerebral dysfunction. Objective. To determine the risk factors of adverse outcomes in patients with severe traumatic brain injury. Material and methods. We performed post hoc analysis of a randomized controlled trial at the Sklifosovsky Research Institute for Emergency Care. Patients with severe traumatic brain injury underwent intensive therapy aimed at normalizing intracranial pressure. In the main group, sevoflurane (AnaConDa) was used for sedation. Sevoflurane can dose-dependently increase cerebral blood flow. However, parallel decrease in brain metabolism leads to cerebral vasoconstriction and decrease in intracranial pressure. Propofol was used in the control group. This drug reduces intracranial blood filling through suppression of metabolism. Manifestation of pneumonia and 30-day mortality were studied. Predictors: drug for sedation, age, gender, body mass index, fact of aspiration, transfusions, acute renal failure, acute respiratory distress syndrome (ARDS), seizures, meningitis. We performed ROC analysis of the SOFA (Sequential Organ Failure Assessment), APACHE II (Acute Physiology and Chronic Health Evaluation), VIS (Vasoactive Inotropic Score), and GCS (Glasgow Coma Scale) scales, as well as oxygen extraction ratio (OER) and age. Results. Risk factors of 30-day mortality: older age (p=0.011), pneumonia (p=0.038), ARDS (p=0.011), decreased OER, negative dynamics according to the MACCE (incidence of major adverse cardiovascular events), VIS, SOFA, APACHE II, GCS scales. The risk of pneumonia is associated with propofol (p=0.028), ARDS (p=0.001), high MACCE score (p=0.038), APACHE II (p=0.040), and GCS (p=0.012) scores, blood transfusion. Conclusion. Early detection of predictors of unfavorable outcomes is valuable to optimize therapy and increase the effectiveness of treatment.