Mahmoodkhani Mehdi, Naeimi Arvin, Zohrehvand Amirhosein, Sabouri Masih, Heidari Mohammad
Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
Caspian J Intern Med. 2024 Sep 7;15(4):673-681. doi: 10.22088/cjim.15.4.673. eCollection 2024 Fall.
Traumatic brain injury (TBI) is one of the most common causes of death and disability worldwide. Stress ulcers are common in critically ill patients and can lead to life-threatening gastrointestinal bleeding (GIB). This study investigates the impact of predisposing factors on GIB and outcomes of TBI patients.
This retrospective cohort study included TBI patients admitted between February 2019 and November 2021. Patients' demographic information and clinical characteristics were collected and divided into Post-TBI GIB and No-GIB groups. During clinical follow-up, the Glasgow Outcome Score (GOS) and mortality were assessed. The correlation between predisposing factors and GIB was investigated.
Out of 164 eligible patients, 66.5% were males, and the mean age was 31.38 ± 13.44 years. There was a higher rate of severe TBIs (p<0.001), intra-axial lesions (P=0.014), hypotension at admission (p<0.001), and concurrent coagulopathies (p<0.001) in the Post-TBI GIB group compared to the No-GIB group. In contrast, the Glasgow Coma Scale (GCS) level upon admission and discharge (p<0.001) and serum hemoglobin level at admission (p<0.001) were lower in the Post-TBI GIB group than in the other group. Moreover, primary GCS (P=0.017) and hypotension at admission (P=0.009), spinal injury (P=0.028), and intra-axial brain injury (P=0.018) were independently associated with GIB in TBI patients.
Primary GCS and hypotension at admission, spinal injury, and intra-axial brain injury are independent predictors for GIB in TBI patients. The presence of GIB in TBI patients is associated with worse neurological outcomes as assessed by GOS at approximately 18 months.
创伤性脑损伤（TBI）是全球范围内死亡和残疾的最常见原因之一。应激性溃疡在重症患者中很常见，可导致危及生命的胃肠道出血（GIB）。本研究调查了易感因素对TBI患者GIB及预后的影响。
这项回顾性队列研究纳入了2019年2月至2021年11月期间收治的TBI患者。收集患者的人口统计学信息和临床特征，并分为TBI后GIB组和非GIB组。在临床随访期间，评估格拉斯哥预后评分（GOS）和死亡率。研究易感因素与GIB之间的相关性。
在164例符合条件的患者中，66.5%为男性，平均年龄为31.38±13.44岁。与非GIB组相比，TBI后GIB组中重度TBI（p<0.001）、轴内病变（P=0.014）、入院时低血压（p<0.001）和并发凝血障碍（p<0.001）的发生率更高。相比之下，TBI后GIB组入院时和出院时的格拉斯哥昏迷量表（GCS）水平（p<0.001）以及入院时的血清血红蛋白水平（p<0.001）低于另一组。此外，原发性GCS（P=0.017）、入院时低血压（P=0.009）、脊髓损伤（P=0.028）和轴内脑损伤（P=0.018）与TBI患者的GIB独立相关。
原发性GCS、入院时低血压、脊髓损伤和轴内脑损伤是TBI患者GIB的独立预测因素。TBI患者中GIB的存在与约18个月时通过GOS评估的更差神经功能预后相关。
