Risk factors and outcomes associated with systolic dysfunction following traumatic brain injury

Author:

Li Jungen1ORCID,Miao Yuzhu2,Zhang Guoxing3,Xu Xiaowen4,Guo Yanxia5,Zhou Bingyuan2,Jiang Tingbo2,Lu Shiqi1

Affiliation:

1. Department of Emergency, the First Affiliated Hospital of Soochow University, Suzhou, China

2. Department of Echocardiography, the First Affiliated Hospital of Soochow University, Suzhou, China

3. Department of Physiology and Neuroscience, Medical College of Soochow University, Suzhou, China

4. Department of Emergency, Suzhou Municipal Hospital of Nanjing Medical University, Suzhou, China

5. Department of Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, China.

Abstract

Systolic dysfunction has been observed following isolated moderate–severe traumatic brain injury (Ims-TBI). However, early risk factors for the development of systolic dysfunction after Ims-TBI and their impact on the prognosis of patients with Ims-TBI have not been thoroughly investigated. A prospective observational study among patients aged 16 to 65 years without cardiac comorbidities who sustained Ims-TBI (Glasgow Coma Scale [GCS] score ≤12) was conducted. Systolic dysfunction was defined as left ventricular ejection fraction <50% or apparent regional wall motion abnormality assessed by transthoracic echocardiography within 24 hours after admission. The primary endpoint was the incidence of systolic dysfunction after Ims-TBI. The secondary endpoint was survival on discharge. Clinical data and outcomes were assessed within 24 hours after admission or during hospitalization. About 23 of 123 patients (18.7%) developed systolic dysfunction after Ims-TBI. Higher admission heart rate (odds ratios [ORs]: 1.05, 95% confidence interval [CI]: 1.02–1.08; P = .002), lower admission GCS score (OR: 0.77, 95% CI: 0.61–0.96; P = .022), and higher admission serum high-sensitivity cardiac troponin T (Hs-cTnT) (OR: 1.14, 95% CI: 1.06–1.22; P < .001) were independently associated with systolic dysfunction among patients with Ims-TBI. A combination of heart rate, GCS score, and serum Hs-cTnT level on admission improved the predictive performance for systolic dysfunction (area under curve = 0.85). Duration of mechanical ventilation, intensive care unit length of stay, and in-hospital mortality of patients with systolic dysfunction was higher than that of patients with normal systolic function (P < .05). Lower GCS (OR: 0.66, 95% CI: 0.45–0.82; P = .001), lower admission oxygen saturation (OR: 0.82, 95% CI: 0.69–0.98; P = .025), and the development of systolic dysfunction (OR: 4.85, 95% CI: 1.36–17.22; P = .015) were independent risk factors for in-hospital mortality in patients with Ims-TBI. Heart rate, GCS, and serum Hs-cTnT level on admission were independent early risk factors for systolic dysfunction in patients with Ims-TBI. The combination of these 3 parameters can better predict the occurrence of systolic dysfunction.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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