Invest Clin 65(1): 16 - 26, 2024 https://doi.org/10.54817/IC.v65n1a02

Corresponding Author: Feixiong Chen, Department of Cerebrovascular Disease, Second Affiliated Hospital of Kun-

ming Medical University, No. 374 Yunnan-Burma Road, Wuhua District, Kunming, Yunnan, 650106, China. Phone:

+86-15808893575. Email: hbchenfx@163.com

Predictive value of intracranial pressure-

related parameters and coagulation

on the prognosis in patients with

traumatic brain injury.

Linna Shen1, Haibin Lu2, Shuibo Yang3 and Feixiong Chen4

1Department of Critical Care Medicine, Yunnan St. John's Hospital, Kunming, China.

2Department of Critical Care Medicine, Daping Hospital, Army Medical University,

Chongqing, China.

3Department of Anesthesiology, People’s Hospital of Yuxi City, Yuxi, China.

4Department of Cerebrovascular Disease, Second Affiliated Hospital of Kunming Medical

University, Kunming, China.

Keywords: brain trauma; intracranial pressure; coagulation; prognosis.

Abstract. This study investigated the factors affecting the prognosis of

patients with traumatic brain injury (TBI) and assessed the predictive value of

intracranial pressure-related parameters and coagulation on prognosis. Seventy

TBI patients admitted between January 2020 and January 2021 were catego-

rized into good prognosis (n=42) and poor prognosis (n=28) groups according

to the Glasgow Outcome Scale (GOS) score upon discharge. Factors affecting

prognosis were analyzed, and differences in intracranial pressure and coagula-

tion between the two groups were compared. The receiver operating charac-

teristic curve (ROC) was used to calculate the predictive value of intracranial

pressure-related parameters and coagulation function on prognosis. Within

24 h postoperatively, the good prognosis group had lower levels of intracra-

nial pressure (ICP) and partial pressure of oxygen in brain tissue (PbtO2) and

higher cerebral perfusion pressure (CPP) and cerebral hemodynamic param-

eters than the poor prognosis group (p<0.05). The good prognosis group had

significantly lower prothrombin time (PT), activated partial thromboplastin

time (aPTT),and prothrombin time (TT) levels and higher platelets (PLT) and

fibrinogen (Fib) levels than the poor prognosis group (p<0.05). Regression

analysis revealed that CPP, systolic blood flow velocity (Vs), end-diastolic blood

flow velocity (Vd), mean blood flow velocity (Vm), PLT, Fib were independent

protective factors for the prognosis, and ICP, PbtO2, PT, APTT, and TT were

risk factors for prognosis. The ROC revealed that ICP, CPP, PbtO2, Vs, Vd, Vm,

APTT, PLT, Fib exhibited high diagnostic value for poor prognosis (AUC=0.732,

0.940, 0.796, 0.706, 0.914, 0.729, 0.876, 0.709, 0.866), with ICP showing the

Factors affecting the prognosis of patients with traumatic brain injuries 17

Vol. 65(1): 16 - 26, 2024

Valor predictivo de los parámetros relacionados con la presión

intracraneal y la coagulación en el pronóstico de pacientes

con traumatismo craneoencefálico.

Invest Clin 2024; 65 (1): 16 – 26

Palabras clave: traumatismo cerebral; presión intracraneal; coagulación; pronóstico.

Resumen. Este estudio investigó factores influyentes en el pronóstico de pa-

cientes con traumatismo craneoencefálico (TCE) y evaluó la utilidad predictiva de

parámetros relacionados con la presión intracraneal y la coagulación. Setenta pa-

cientes 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). Tam-

bién 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, oxí-

geno 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.

Received: 17-01-2023 Accepted: 26-09-2023

INTRODUCTION

Traumatic brain injury (TBI) is an in-

jury to the brain caused by a blow or jolt to

the head from blunt or penetrating trauma

where the dura mater remains intact while

the contents of the cranial cavity have not

yet come into contact with the outside. A

blow or bump mainly causes it, or a jolt to

the head, the head suddenly and violently

hitting an object, or when an object pierc-

es the skull and enters brain tissue 1,2. The

highest diagnostic sensitivity and Vd showing the highest diagnostic specificity.

Intracranial pressure-related parameters and coagulation indicators are prog-

nosis-related indexes in patients with TBI, and the prognosis and survival can

be improved by controlling intracranial pressure and improving coagulation.

18 Shen et al.

Investigación Clínica 65(1): 2024

skull of patients with TBI is deformed and

fractured, causing movement of brain tissue

in the cranial cavity, resulting in increased

pressure on the cranial vault, compression of

cerebral vessels, damage to the central ner-

vous system, and inadequate vascular perfu-

sion, which seriously threatens the patients’

lives3. For now, monitoring of intracranial

pressure and pre-and post-operative coagula-

tion can aid in selecting surgical procedures,

and strict control and adjustment of the in-

tracranial pressure can minimize post-oper-

ative mortality in patients. However, their

effect on post-operative recovery and prog-

nostic outcome still needs to be explored 4.

Seventy patients with TBI were enrolled in

this study, and the effects of intracranial

pressure-related parameters and coagula-

tion indicators on prognosis were explored,

aiming to provide new ideas for improving

the quality of prognosis of TBI patients.

MATERIALS AND METHODS

Baseline data

Seventy patients with TBI admitted to

The First People’s Hospital of Yibin between

January 2020 and January 2021 were en-

rolled, and patients with Glasgow Outcome

Scale (GOS) 5 scores of grades III-IV were clas-

sified as the good prognosis group (n=42),

and patients with GOS scores of grades I-II

or death were defined as the poor prognosis

group (n=28). The study has been approved

by the medical ethics committee of The First

People’s Hospital of Yibin. The research ob-

jects and their families were informed, and

they signed a fully informed consent form.

Inclusion criteria: TBI was confirmed by

cranial CT scan, and history of cranial trauma

was determined; patients with TBI confirmed

by clinical examination; patients who sought

medical help within a short period after the

onset of the disease, and there might be pro-

gression; patients who received craniocere-

bral trauma surgery in our hospital. Exclu-

sion criteria: TBI combined with more severe

organ dysfunction; combined or with other

coagulation-related diseases; developed criti-

cal and life-threatening conditions after ad-

mission, with a predicted survival time of less

than three months; incomplete medical re-

cords and lost to follow-up.

METHODS

After patients were enrolled, baseline

data was collected from both groups, includ-

ing gender, age, cause of injury, Glasgow

coma scale (GCS) upon admission, time

from injury to admission, length of stay

in the neurosurgical intensive care unit

(NICU), and parameters related to intracra-

nial pressure (ICP).

In both groups, 5 mL of venous blood

were collected from the anterior region of

the elbow in a fasting state, followed by cen-

trifugation (3000 r/min, 10 min) at 4 °C to

obtain platelet-poor plasma, and was stored

at -80 °C. The coagulation indicators were

measured by an optical coagulation analyzer

(BIObase, XL1000C, China), including pro-

thrombin time (PT), activated partial throm-

boplastin time (APTT), thrombin time (TT),

platelets (PLT), and fibrinogen (Fib) 6,7.

TBI surgery was determined according

to the Guidelines for the Treatment of Major

Craniocerebral Trauma (4th edition), and

ICP, partial oxygen pressure (PbtO2), cere-

bral perfusion pressure (CPP), and cerebral

blood flow velocity were recorded within 24

h after surgery 8,9. ICP was monitored using

an intracranial pressure monitor (HP Inc.,

USA). ICP levels and ICP waveform ampli-

tude were recorded every hour, and non-in-

vasive mean ICP was calculated according to

the potential superposition principle. With a

GMS-5002 oxygen sensor (GMS, Germany),

PbtO2 was measured during surgery and 24

h after surgery with a normal brain area in

the lateral brain as the puncture point by

piercing the electrode and probing the nee-

dle about 34 mm deep into the meninges.

The recording interval was 15 seconds. The

arterial blood pressure was monitored using

a non-invasive blood pressure monitor (HP,

Factors affecting the prognosis of patients with traumatic brain injuries 19

Vol. 65(1): 16 - 26, 2024

USA). The instrument depicted pressure

waves by arterial blood pressure fluctuations.

The mean arterial blood pressure was calcu-

lated with multiple sets of pressure waves.

Cerebral hemodynamics was monitored us-

ing an EK-1000B transcranial Doppler ul-

trasound instrument (Jiangsu Yikang Elec-

tronic Technology Co., Ltd., 201182230620)

with a probe frequency of 2 MHz to detect

cerebral blood flow velocity in the cerebral

arteries, including systolic blood flow veloc-

ity (Vs), end-diastolic blood flow velocity

(Vd), and mean blood flow velocity (Vm) 10.

Follow-up visits

Patients were followed up consistently

for three months after discharge, and GOS

scores were recorded. Grade V (low disabil-

ity): light damage with minor neurological

and psychological deficits; Grade IV (mod-

erate disability): no need for assistance in

everyday life; employment was possible but

may require special equipment; Grade III

(Severe disability): severe injury with perma-

nent need for help with daily living, Grade II

(Persistent vegetative state): severe damage

with prolonged state of unresponsiveness

and a lack of higher mental functions; Grade

I (Death): severe injury or death without re-

covery of consciousness.

Statistical analysis

The data of this study were analyzed

using IBM® SPSS 22.0 software. The count

data were expressed as n and % and exam-

ined by the χ2 test. The measurement data

were expressed by (x±sd) and examined by

the t-test. The correlation of intracranial

pressure-related parameters with coagula-

tion function and poor prognosis was ana-

lyzed using the Pearson correlation analysis.

Binary logistic regression was used to ana-

lyze the factors influencing the prognosis of

TBI, and the ROC was used to calculate the

predictive value of intracranial pressure-re-

lated parameters and coagulation for prog-

nosis. An area under the curve (AUC) of 0.7

to 0.9 represents a specific predictive value,

and an AUC > 0.9 represents a higher pre-

dictive value. p<0.05 represents a statisti-

cally significant difference.

RESULTS

Comparison of baseline data

There were no significant differences be-

tween the two groups in terms of gender, age,

cause of injury, GCS score upon admission,

time from injury to admission, duration of

ICP-related parameter monitoring, and dura-

tion of NICU stay (p>0.05) (Table 1).

Comparison of intracranial pressure-

related parameters between the two groups

Within 24 h after surgery, patients in

the good prognosis group had significantly

lower ICP and PbtO2 levels and significantly

higher CPP and cerebral hemodynamic in-

dexes than those in the poor prognosis group

(p<0.05) (Table 2).

Changes in coagulation in both groups

Within 24 h after surgery, patients in the

good-prognosis group had significantly lower

PT, APTT, and TT levels and significantly high-

er PLT and Fib levels than those in the poor-

prognosis group (p<0.05) (Table 2).

The predictive value of intracranial

pressure-related parameters and

coagulation on prognosis

ICP, PbtO2, PT, APTT, TT were signifi-

cantly positively correlated with poor progno-

sis, and CPP, Vs, Vd, Vm, PLT, and Fib were

significantly negatively correlated with poor

prognosis (p<0.05, Table 3). Logistic regres-

sion analysis revealed that CPP, Vs, Vd, Vm,

PLT, and Fib were prognostic independent

protective factors, and ICP, PbtO2, PT, APTT,

and TT were prognostic risk factors (Table 4).

ICP, CPP, PbtO2, Vs, Vd, Vm, APTT, PLT, and

Fib exhibited high diagnostic value for poor

prognosis (AUC>0.7), with ICP showing the

highest diagnostic sensitivity and Vd showing

the highest diagnostic specificity (Table 5

and Fig. 1).

20 Shen et al.

Investigación Clínica 65(1): 2024

DISCUSSION

Closed craniocerebral trauma is a com-

mon and severe TBI, and its incidence in-

creases year by year. Compared with open

craniocerebral trauma, the symptoms and

signs of closed craniocerebral trauma are

less obvious, but its potential harm cannot be

ignored. Patients with closed craniocerebral

trauma not only face the threat of life safety

but also may lead to long-term neurological

dysfunction and decreased quality of life.

Table 1

Comparison of general information between the two groups.

Variable Good prognosis

group (n=42)

Poor prognosis

group (n=28)

t/χ2 values p

Gender (m/f, n) 23/19 15/13 0.010 0.922

Age (years) 41.72±14.48 43.88±15.36 0.597 0.553

Cause of injury Blow 8 (19.05) 6 (21.43) 0.060 0.807

Fall 11 (26.19) 8 (28.57) 0.048 0.826

Traffic accidents 16 (38.10) 11 (39.29) 0.010 0.920

Other 7 (16.67) 3 (10.71) 0.486 0.486

Admission GCS score 8.45±3.04 7.84±2.42 0.890 0.377

Time from injury to admission (hours) 2.25±1.53 2.40±1.32 0.424 0.673

Duration of ICP-related parameters

monitoring (hours)

148.68±10.72

151.76±12.19

1.115

0.269

Length of stay in NICU (hours) 90.59±40.43 79.48±48.37 1.041 0.302

Glasgow Coma Score (GCS), Intracranial Pressure (ICP), Neurosurgical Intensive Care Unit (NICU).

Table 2

Comparison of intracranial pressure-related parameter and coagulation parameters

between the two groups.

Variable Good prognosis

group (n=42)

(x±sd)

Poor prognosis

group (n=28)

(x±sd)

t/χ2 values p

ICP (mmHg) 14.00±5.70 26.25±13.49 5.239 ≤0.001

CPP (mmHg) 81.18±6.94 48.98±19.95 9.650 ≤0.001

PbtO2 (mmHg) 9.17±5.62 19.31±9.58 5.580 ≤0.001

Hemodynamics

(cm/s)

Vs 84.75±13.24 75.24±11.30 3.117 0.003

Vd 57.86±7.50 46.53±4.75 7.092 ≤0.001

Vm 53.44±6.61 46.38±8.85 3.818 ≤0.001

PT (s) 13.27±2.89 15.47±3.10 3.031 0.003

APTT (s) 30.52±3.63 37.93±5.54 6.769 ≤0.001

TT (s) 17.30±3.18 19.29±3.98 2.318 0.023

PLT (109/L) 148.62±45.69 119.41±30.28 2.972 0.004

Fib (g/L) 2.51±0.35 2.12±0.15 6.399 ≤0.001

Intracranial pressure (ICP), cerebral perfusion pressure (CPP), partial pressure of oxygen in brain tissue (PbtO2), systolic

blood flow velocity (Vs), end-diastolic blood flow velocity (Vd), mean blood flow velocity (Vm), prothrombin time (PT),

activated partial thromboplastin time (aPTT), prothrombin time (TT), seconds (s), platelets (PLT), fibrinogen (Fib).

Factors affecting the prognosis of patients with traumatic brain injuries 21

Vol. 65(1): 16 - 26, 2024

Predicting the prognosis of patients

with closed craniocerebral trauma has been

the focus of the medical community. Under-

standing the prognostic influencing factors

and effective predictive indicators can help

doctors better assess patients’ conditions

and predict their future development trends

and provide an important basis for clinical

decision-making to take timely intervention

measures to improve patient prognosis.

TBI is frequent in the neurosurgical

emergency setting, with a mortality rate

of 30%-50% for severe TBI, resulting in dis-

ability or other types of complications. For

TBI, a hard blow to the head could cause

an intracranial hematoma, cerebral edema,

brain herniation due to brain tissue disloca-

tion, and elevated ICP (ICP >20 mm Hg for

more than 15 min within one hour of the

blow), which threaten the life and health of

the patient 11,12. Due to an increase in deadly

traffic accidents, falls on construction sites,

and collisions, the incidence of TBI is show-

ing an increasing trend 13. For the current

treatment options of TBI, decompressive

craniectomy and cerebrospinal fluid drain-

age, nutritional support, and ICP monitor-

ing can significantly reduce the length of

Table 3

Correlation analysis of intracranial pressure-related parameters, coagulation and poor prognosis.

Variable ICP CPP PbtO2Vs Vd Vm PT APTT TT PLT Fib

r 0.394 -0.746 0.502 -0.349 -0.703 -0.388 0.316 0.638 0.257 -0.355 -0.559

p 0.001 ≤0.001 ≤0.001 0.003 ≤0.001 0.001 0.008 ≤0.001 0.032 0.003 ≤0.001

Intracranial pressure (ICP), cerebral perfusion pressure (CPP), partial pressure of oxygen in brain tissue (PbtO2),

systolic blood flow velocity (Vs), end-diastolic blood flow velocity (Vd), mean blood flow velocity (Vm), prothrombin

time (PT), activated partial thromboplastin time (aPTT), prothrombin time (TT), platelets (PLT), fibrinogen (Fib),

r (Pearson correlation coefficient).

Table 4

Factors influencing the prognosis of patients with TBI.

Variable B S.E. Wald p Exp (B) 95% EXP (B) Confidence interval

lower limit upper limit

ICP 0.121 0.032 14.458 ≤0.001 1.129 1.060 1.201

CPP -0.204 0.051 16.078 ≤0.001 0.815 0.738 0.901

PbtO2 0.169 0.043 15.266 ≤0.001 1.184 1.088 1.289

Vs -0.065 0.024 7.511 0.006 0.937 0.894 0.982

Vd -0.286 0.068 17.716 ≤0.001 -798 0.657 0.858

Vm -0.124 0.039 10.168 0.001 0.883 0.818 0.953

PT 0.250 0.091 7.499 0.006 1.284 1.074 1.535

APTT 0.358 0.084 18.367 ≤0.001 1.431 1.215 1.686

TT 0.163 0.074 4.805 0.028 1.177 1.017 1.361

PLT -0.018 0.007 7.422 0.006 0.982 0.969 0.995

Fib -4.780 1.213 15.533 0.000 0.0080 0.001 0.090

B>1 is a risk factor and B<1 is a protective factor.

Intracranial pressure (ICP), cerebral perfusion pressure (CPP), partial pressure of oxygen in brain tissue (PbtO2),

systolic blood flow velocity (Vs), end-diastolic blood flow velocity (Vd), mean blood flow velocity (Vm), prothrombin

time (PT), activated partial thromboplastin time (aPTT), prothrombin time (TT), platelets (PLT), fibrinogen (Fib).

22 Shen et al.

Investigación Clínica 65(1): 2024

Table 5

Analysis of the predictive value of intracranial pressure-related parameters and coagulation

for poor prognosis.

Variable AUC Jorden

index

Sensitivity Specificity Standard

Error

Asymptotic 95%

confidence interval

p lower

limit

upper

limit

ICP 0.732 0.547 0.976 0.571 0.069 0.001 0.598 0.867

CPP 0.940 -0.834 0.905 0.071 0.036 ≤0.001 0.869 1.000

PbtO20.796 0.523 0.952 0.571 0.055 ≤0.001 0.687 0.905

Vs 0.706 -0.416 0.452 0.036 0.062 0.004 0.585 0.827

Vd 0.914 0.095 0.893 0.893 0.037 ≤0.001 0.841 0.987

Vm 0.729 -0.488 0.952 0.464 0.064 0.001 0.604 0.854

PT 0.686 0.345 0.881 0.464 0.065 0.009 0.559 0.814

APTT 0.876 0.679 0.929 0.750 0.049 ≤0.001 0.779 0.973

TT 0.651 0.310 0.881 0.429 0.069 0.033 0.516 0.787

PLT 0.709 -0.464 0.500 0.036 0.063 0.003 0.586 0.833

Fib 0.866 0.691 0.929 0.762 0.047 ≤0.001 0.775 0.958

Area under the curve (AUC) Intracranial pressure (ICP), cerebral perfusion pressure (CPP), partial pressure of

oxygen in brain tissue (PbtO2), systolic blood flow velocity (Vs), end-diastolic blood flow velocity (Vd), mean blood

flow velocity (Vm), prothrombin time (PT), activated partial thromboplastin time (aPTT), prothrombin time (TT),

platelets (PLT), fibrinogen (Fib).

Fig. 1. ROC analysis of the predictive value of intracranial pressure and coagulation function on adverse prognosis.

Intracranial pressure (ICP), cerebral perfusion pressure (CPP), partial pressure of oxygen in brain tissue (PbtO2),

systolic blood flow velocity (Vs), end-diastolic blood flow velocity (Vd), mean blood flow velocity (Vm), prothrombin

time (PT), activated partial thromboplastin time (aPTT), prothrombin time (TT), platelets (PLT), fibrinogen (Fib).

Factors affecting the prognosis of patients with traumatic brain injuries 23

Vol. 65(1): 16 - 26, 2024

hospitalization and mortality of patients,

indicating that there is a close link between

the quality of prognosis and ICP levels 14.

In a study by Pan et al. 15 on factors

affecting the prognosis of TBI patients,

patients with favorable outcomes had sig-

nificantly lower average ICP and pressure

reactivity index (PRx) and exhibited signifi-

cantly higher CPP compared with patients

with unfavorable outcomes. ICP is the pres-

sure exerted by fluids such as cerebrospinal

fluid (CSF) inside the skull and on the brain

tissue. When an external blow to the crani-

um triggers cerebral edema, there is an in-

crease in CSF as well as the volume of brain

tissue. Other space-occupying lesions, such

as hematomas, may also occur, causing ob-

struction of the CSF circulation and increas-

ing the CSF pressure and ICP in the cranial

cavity 16,17. In this study, we enrolled patients

with TBI during the same period and found

that the ICP and PbtO2 levels within 24 h

after surgery in patients with good progno-

sis were significantly lower while CPP was

significantly higher than those in the poor

prognosis group, which is consistent with

the findings of other scholars mentioned

above 16,17.

Meanwhile, this study analyzed hemo-

dynamic indices and found that all cerebral

hemodynamics in the poor prognosis group

were lower than those in the good prognosis

group. The results of the correlation analysis

showed a significant negative relationship

between CPP, Vs, Vd, Vm, PLT, and Fib and

poor prognosis (r= -0.746, -0.349, -0.703,

-0.388, -0.355, -0.559, p <0.05). This implies

an association between decreased cerebral

perfusion pressure, venous suction velocity,

velocity of arterial drainage, brain parenchy-

mal volume, PLT count, and Fib and a poor

outcome. Lower cerebral perfusion pressure,

venous suction velocity, arterial drainage ve-

locity, brain parenchyma volume, PLT count,

and Fib may cause brain tissue hypoxia, in-

sufficient perfusion, and impaired coagula-

tion, affecting the patient’s recovery.

In the ROC diagnostic curve, ICP, CPP,

PbtO2, Vs, Vd, Vm, APTT, PLT, and Fib all had

high diagnostic values for poor prognosis.

Vs, Vd, and Vm were all independent protec-

tive factors for the prognosis of TBI patients.

The reason may be that the cerebral vascu-

lar has regulatory functions. When cranial

injury occurs, ICP is elevated, disturbing

brain tissue blood oxygen levels producing a

large amount of hemoglobin, 5-hydroxytryp-

tamine, and angiotensin. The cerebral vascu-

lar regulatory center alleviates blood oxygen

deficiency by regulating ICP, thus repairing

damaged brain nerves and protecting the in-

tracranial microcirculatory balance.

Brain tissue is the organ with the high-

est level of prothrombin kinase. Under the

influence of cranial damage and ICP, coagu-

lation dysfunction of brain tissue also affects

intracranial blood-oxygen balance, which af-

fects the outcome and prognosis of TBI. In

terms of the development pathway of coagu-

lation dysfunction in TBI, when the cranial

brain is damaged, and the blood-brain bar-

rier is impaired, the extrinsic coagulation

mechanism is activated by stress, and a large

amount of thrombin is released from brain

tissue into the blood circulation, resulting in

a local hypercoagulable state in the cranial

brain 18. In the good prognosis Group, PT,

APTT, and TT levels were significantly lower,

while PLT levels were higher than those in the

poor prognosis group, and all factors were

independent influencing factors for poor

prognosis. This suggests that with impaired

coagulation mechanisms, platelet levels may

decrease rapidly. Platelets play a crucial role

in blood coagulation and can accumulate on

damaged blood vessel walls to form a throm-

bus for hemostasis. If platelet numbers are

reduced or their function is abnormal, it

may lead to decreased coagulability, increas-

ing the risk of bleeding. Brain tissue is very

important for adequate blood oxygen supply,

and the decline of platelets may lead to un-

balanced cerebrovascular regulation, further

affecting the blood oxygen level of brain tis-

24 Shen et al.

Investigación Clínica 65(1): 2024

sue and impairing brain function 19,20. This is

probably because TBI causes local tissue dam-

age and bleeding, releasing a large number of

tissue factors and cytokines that activate the

coagulation system. However, when the injury

is too severe or lasts too long, the coagulation

function may be inhibited, and the platelet

aggregation and blood coagulation capacity

may be reduced. This leads to a decrease in

the platelet levels. Second, TBI may lead to

the rupture and bleeding of the capillaries

in the brain tissue. Platelets accumulate at

vascular damage and seal the ruptured capil-

laries by forming platelet primary hemostatic

plugs to prevent further bleeding. Therefore,

when thrombocytopenia occurs, it may in-

dicate damage to platelet consumption and

further bleeding. In addition, platelets re-

lease secretions such as serotonin, dopamine,

and angiotensin, which are involved in vas-

cular regulation and hemodynamic balance

in the lining of blood vessels. When platelet

levels decrease, this cerebrovascular regula-

tion mechanism may be affected, leading to

abnormal blood oxygen levels in brain tissue,

further impairing cerebrovascular regulation.

Therefore, the decrease in platelet levels may

be one of the manifestations of impaired co-

agulation mechanisms and abnormal cere-

brovascular regulation in patients with TBI.

These changes may impact the prognosis of

patients with TBI, and further studies can ex-

plore these associations and determine their

predictive value for the prognosis of patients

with TBI. However, this study only analyzed

the correlation between intracranial pressure-

related parameters, coagulation indexes, and

prognosis without correlating intracranial

pressure with coagulation indexes, and fur-

ther exploration is still needed to determine

their relationship.

In conclusion, intracranial pressure-re-

lated parameters and coagulation indicators

are all related to the prognosis of patients

with TBI, and the prognostic quality and sur-

vival of patients can be improved by regulat-

ing intracranial pressure and improving co-

agulation function.

ACKNOWLEDGMENTS

None.

Data Availability

Due to the nature of this research, par-

ticipants did not agree for their data to be

shared publicly, so supporting data is un-

available.

Conflicts of interest

The authors declare that they have no

competing interests.

Funding

No funds, grants, or other support was

received.

Author’s ORCID numbers

• Linna Shen (LS):

0009-0005-5283-3121

• Haibin Lu (HL):

0009-0008-3272-4595

• Shuibo Yang (SY):

0009-0008-1897-4213

• Feixiong Chen (FC):

0009-0004-5243-7236

Participation in development and writing

of the paper

Concept and design: LS and FC. Acqui-

sition of data, literature review, and refine-

ment of manuscript: All authors. Analysis

and interpretation of data: HL and SY. Man-

uscript writing: LS. Review of final manu-

script: FC.

Factors affecting the prognosis of patients with traumatic brain injuries 25

Vol. 65(1): 16 - 26, 2024

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