Physiological trajectories after traumatic brain injury: markers or makers of disease?

The variability in outcomes after traumatic brain injury (TBI) cannot be fully accounted for by the heterogeneous characteristics of the primary injury and demographics, suggesting that a patient's physiological reaction to the initial insult could play a part in secondary injuries, like cerebral oedema or seizures. 1 Lingsma HF Roozenbeek B Steyerberg EW Murray GD Maas AIR Early prognosis in traumatic brain injury: from prophecies to predictions. Lancet Neurol. 2010; 9: 543-554 Summary Full Text Full Text PDF PubMed Scopus (323) Google Scholar Particularly in patients with TBI who are admitted to intensive care units (ICUs), the physiological reaction is complex—it spans intracranial and extracranial processes, continuously evolves, and is iteratively affected by second insults (eg, hypoxia or hypotension) and therapies. Characterising these patients into groups known as endotypes, to deconstruct the heterogeneity of TBI, could prove invaluable for advancing targeted treatments and precision medicine. However, the rapid and dynamic evolution of clinical and physiological parameters in these patients warrants a study design that leverages their longitudinal trajectories. Clinical descriptors of disease trajectories in patients with traumatic brain injury in the intensive care unit (CENTER-TBI): a multicentre observational cohort studyFirst-day ICU admission data are not the only clinical descriptors of disease trajectories in patients with traumatic brain injury. By analysing temporal variables in our study, variation of glucose was identified as the most important clinical descriptor that might distinguish disease trajectories in the ICU, which should direct further research. Biomarkers of brain injury (S100B, NSE, NFL, tau, UCH-L1, and GFAP) were also top clinical descriptors over time, suggesting they might be important in future clinical practice. Full-Text PDF