Predictive value of intracranial pressure- related parameters and coagulation on the prognosis in patients with traumatic brain injury.

Valor predictivo de los parámetros relacionados con la presión intracraneal y la coagulación en el pronóstico de pacientes con traumatismo craneoencefálico.

• Linna Shen Yunnan St. John's Hospital, Kunming, China. https://orcid.org/0009-0005-5283-3121
• Haibin Lu Daping Hospital, Army Medical University, Chongqing, China. https://orcid.org/0009-0008-3272-4595
• Shuibo Yang People’s Hospital of Yuxi City, Yuxi, China. https://orcid.org/0009-0008-1897-4213
• Feixiong Chen Second Affiliated Hospital of Kunming Medical University, Kunming, China. https://orcid.org/0009-0004-5243-7236

DOI: https://doi.org/10.54817/IC.v65n1a02

Palabras clave: traumatismo cerebral, presión intracraneal, coagulación, pronóstico

Resumen

Este estudio investigó factores influyentes en el pronóstico de pacientes con traumatismo craneoencefálico (TCE) y evaluó la utilidad predictiva de parámetros relacionados con la presión intracraneal y la coagulación. Setenta pacientes ingresados entre enero de 2020 y enero de 2021 se dividieron en dos grupos según su pronóstico: bueno (n=42) y malo (n=28), según la Escala de Resultados de Glasgow (GOS) al alta. Se analizaron factores de pronóstico y se compararon las diferencias en presión intracraneal y coagulación. La curva ROC evaluó el valor predictivo de estos parámetros. En las primeras 24 horas postoperativas, el grupo de buen pronóstico mostró menor presión intracraneal (PIC) y mayor presión de perfusión cerebral (CPP) y parámetros hemodinámicos cerebrales (p<0,05). También presentaron niveles más bajos de tiempo de protrombina (TP), tiempo parcial de tromboplastina (TTPA) y trombina (TT), y niveles más altos de plaquetas (PLT) y fibrinógeno (Fib) (p<0,05). El análisis de regresión identificó a CPP, la velocidad de flujo sistólico (Vs), la velocidad de flujo diastólico (Vd) , la velocidad de flujo medio (Vm), PLT y Fib como factores protectores independientes, mientras que PIC, oxígeno cerebral (PbtO2), TP, TTPA y TT fueron factores de riesgo. La ROC demostró que PIC, CPP, la presión parcial de oxigeno cerebral (PbtO2 ), Vs, Vd, Vm, TTPA, PLT y Fib tenían un alto valor diagnóstico para mal pronóstico (AUC=0.732, 0.940, 0.796, 0.706, 0.914, 0.729, 0.876, 0.709, 0.866), siendo PIC el más sensible y Vd el más específico. Los parámetros intracraneales y de coagulación se relacionan con el pronóstico en pacientes con TCE, y mejorar el control de la PIC y la coagulación puede mejorar la supervivencia.

Citas

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