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Background <p>Traumatic brain injury (TBI) is recognized as a significant global public health issue associated with high morbidity and mortality. This study aimed to overcome the limitations of traditional prognostic models (e.g., International Mission on Prognosis and Analysis of Clinical Trials, IMPACT) by evaluating the red cell distribution width-to-serum calcium ratio (RCR) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) to determine their prognostic value among patients with moderate-to-severe TBI.</p> Methods <p>We retrospectively analyzed 210 consecutive patients admitted to the Trauma Center and Department of Neurosurgery, First Affiliated Hospital of Soochow University (January 2023–January 2025). Demographic, clinical, laboratory, and radiological data were collected. The primary endpoint was 6‑month unfavorable outcome (Glasgow Outcome scale score &lt; 4). Associations between biomarkers and outcome were estimated using multivariable logistic regression. Nonlinearity was examined with restricted cubic splines. Discrimination was compared using receiver operating characteristic curves.</p> Results <p>Higher RCR and NT‑proBNP were independently associated with unfavorable outcome [adjusted OR for RCR, 4.871; 95% CI 1.929–12.300; adjusted OR for ln(NT‑proBNP), 2.495; 95% CI 1.648–3.776; both<i> p</i> &lt; 0.001]. Rates of unfavorable outcome rose across RCR tertiles (21.4%, 47.9%, and 63.8%; <i>p</i> &lt; 0.001). Adding both biomarkers to the IMPACT model improved discrimination (AUC 0.924 vs. 0.874; <i>p</i> &lt; 0.001).</p> Conclusions <p>Combined assessment of RCR and NT-proBNP enhances early prognostic accuracy in moderate-to-severe TBI, supporting their potential role as accessible biomarkers for refined risk stratification and individualized management.</p>

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Development and Validation of a Prognostic Model Integrating the Red Cell Distribution Width-to-Serum Calcium Ratio and N-terminal pro–B-type Natriuretic Peptide for Outcome Prediction after Moderate-to-Severe Traumatic Brain Injury

  • 期刊论文

  • 发表日期：

    2026年2月19日

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  • Lu Liu,
  • Chenyu Wu,
  • Xiaoyu Wang,
  • Chenyue Pu,
  • Feng Xu,
  • Peng Yang

摘要

Background

Traumatic brain injury (TBI) is recognized as a significant global public health issue associated with high morbidity and mortality. This study aimed to overcome the limitations of traditional prognostic models (e.g., International Mission on Prognosis and Analysis of Clinical Trials, IMPACT) by evaluating the red cell distribution width-to-serum calcium ratio (RCR) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) to determine their prognostic value among patients with moderate-to-severe TBI.

Methods

We retrospectively analyzed 210 consecutive patients admitted to the Trauma Center and Department of Neurosurgery, First Affiliated Hospital of Soochow University (January 2023–January 2025). Demographic, clinical, laboratory, and radiological data were collected. The primary endpoint was 6‑month unfavorable outcome (Glasgow Outcome scale score < 4). Associations between biomarkers and outcome were estimated using multivariable logistic regression. Nonlinearity was examined with restricted cubic splines. Discrimination was compared using receiver operating characteristic curves.

Results

Higher RCR and NT‑proBNP were independently associated with unfavorable outcome [adjusted OR for RCR, 4.871; 95% CI 1.929–12.300; adjusted OR for ln(NT‑proBNP), 2.495; 95% CI 1.648–3.776; both p < 0.001]. Rates of unfavorable outcome rose across RCR tertiles (21.4%, 47.9%, and 63.8%; p < 0.001). Adding both biomarkers to the IMPACT model improved discrimination (AUC 0.924 vs. 0.874; p < 0.001).

Conclusions

Combined assessment of RCR and NT-proBNP enhances early prognostic accuracy in moderate-to-severe TBI, supporting their potential role as accessible biomarkers for refined risk stratification and individualized management.