Research Reports - Risk factors for early hemorrhagic progression after traumatic brain injury

J Neurotrauma. 2015 Jan 4

Kim H(1), Jin ST, Kim YW, Kim SR, Park IS, Jo KW

The purpose of this study was to identify the risk factors related to the
hemorrhagic progression (HP) of brain contusion in patients after traumatic brain
injury (TBI). Recently, many studies have reported abnormal lipid levels
associated with hemorrhagic stroke. However, unlike hemorrhage stroke, the lipid
profiles in TBI patients have not been examined. Therefore, we evaluated the risk
factors of HP in TBI patients and focused on lipid profiles. Fifty-six TBI
patients with mild to moderate injuries (Glasgow Coma Scale ≥9) who initially did
not require surgical intervention were enrolled in this study. Patients underwent
repeated computed tomographic (CT) scans at 4 hours and 24 hours after injury.
Magnetic resonance imaging (MRI) was performed 7 days after the initial injury.
In each noncontrast CT scan, the hemorrhage volume was quantified using the ABC/2
technique. Clinical features, pervious medical history, initial CT and
microbleeding on follow up MRI were analyzed retrospectively. Thirty-one patients
(55%) developed significant HP (volume>30%). Current smoking (p=0.034), higher
initial systolic blood pressure (p=0.035), and lower triglyceride levels
(p=0.039) were significantly associated with HP. Current smoking and a TG level
<150 mg/dL were the only statistically significant predictors of HP in the
multivariate analysis (p = 0.019, p = 0.021, respectively). HP with TBI is common
in patients who currently smoke and have lower TG levels (150 mg/dL). These
patients would be monitored closely, and surgery may be considered before
deterioration occurs.

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