Establishing prognostic significance of hypoxia predictors in patients with acute cerebral pathology

ABSTRACT

Objectives

This research aims to study the prognostic role of serum S100 as a predictor of mortality in vascular and traumatic brain injuries.

Methods

This prospective cohort study involved 219 patients. In the blood serum, neuron-specific markers (S100, NSE) and glucose, acid-base state and gas composition of arterial blood were obtained at admission, on the 3rd, 5th and 7th days of patients' stay in the intensive care unit.

Results

The most significant risk factor for an unfavorable outcome is the marker S100 with a cut-off point of 0.2 mcg/l. The analysis results indicate a statistically significant direct relationship between S100 > 0.2 mcg/l and NSE ≥ 18.9 ng/ml compared to other variables, while the chance ratio (OR) is 11.9 (95%CI:3.2927-1.6693;). With blood sugar increase above 7.4 mmol/l, the OR is 3.82 (95% CI: 2.1289-0.5539;); with a Glasgow scale below 13 points, the OR is 3.69 (95% CI: 2.1316-0.4819;); with an increase in pCO2 < 43.5 mm Hg, the OR was 3.15 (95% CI: 1.8916- 0.4062;). The obtained model certainty measure according to pseudo R2 Nagelkerke criterion is 263.5, showing the excellent quality of the mathematical model’s predictive ability. The developed prognostic model, including the dependent variable S100 and independent variables as predictors of a poor outcome of NSE, pCO2, GCS and Hb, reached a cut-off point of 84.51%, AUC - 0.88 with high levels of sensitivity and specificity: 91.89% and 64.14%, respectively.

Novelty

This model can be used to predict the outcome in patients with acute cerebral pathology.

KEYWORDS:

• Strokes
• traumatic brain injuries
• neuron-specific markers
• diagnostic criteria
• prognostic criteria
• stroke outcome

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Zhanslu Sarkulova

Zhanslu Sarkulova is a Professor, Doctor of Medical Sciences, Head of the Department of Anesthesiology and Resuscitation, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan.

Ainur Tokshilykova

Ainur Tokshilykova is a Ph.D. student at the Department of Anesthesiology and Resuscitation, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan.

Alima Khamidulla

Alima Khamidulla is a Ph.D., Associate Professor of the Neurology Department, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan.

Aigul Utepkaliyeva

Aigul Utepkaliyeva is a Сandidate of Medical Sciences, the Head of the Neurology Department, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan.

Dinmukhamed Ayaganov

Dinmukhamed Ayaganov is a Ph.D., Associate Professor of the Department of Neurology with a course in the Psychiatry and Narcology Department, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan.

Marat Sarkulov

Marat Sarkulov is a Сandidate of Medical Sciences, the Head of the Urology Department, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan.

Tomas Tamosuitis

Tomas Tamosuitis is a M.D., Ph.D., the Head of the Neurosurgery Intensive Care Unit Neurosurgery Department, the Head of the organ procurement program of the Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Department of Intensive Care Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.