The role of cardiac injury score in the prediction of the functional outcome in patients with isolated severe traumatic brain injury

Abstract

Background Neurogenic stress cardiomyopathy has been described in various neurological and neurosurgical conditions, but in cases of traumatic brain injury (TBI), neurocardiogenic injury was documented in a few case reports and case series with no information about patient outcome. This work aims to study the role of cardiac injury score (CIS) in the prediction of the functional outcome in patients with isolated severe TBI. Patients and methods We enrolled 100 adult patients with severe isolated TBI, admitted to the ICU. APACHE II score, hemodynamic data, routine laboratory work, computed tomography brain, ECG, serum troponin I, transthoracic echocardiography, and Glasgow Outcome Scale (GOS) were recorded. Then patients were subdivided into two groups at the end of the study (3 months) according to GOS: good outcome; GOS III, IV, V (36 patients) and poor outcome; GOS I, II (64 patients). The CIS was calculated for each patient. Results A receiver operating characteristic curve was performed to evaluate the ability of CIS and its different parameters to predict poor outcomes. The area under the curve for CIS, troponin I, ejection fraction, systolic blood pressure, and diastolic blood pressure were 0.839 (confidence interval 0.762–0.916; P <0.001), 0.813 ( P <0.001), 0.804 ( P <0.001), 0.789 ( P <0.001), and 0.729 ( P <0.001), respectively. Conclusion CIS and its components have the advantage of having good sensitivity and specificity for the prediction of the functional outcome and the prognosis of patients with severe isolated TBI and can guide clinicians in their management plan.