Biomarkers of Physiological Disturbances for Predicting Mortality in Decompressive Craniectomy

OBJECTIVE Of many critical care regimens, the management of physiological disturbances in serum is particularly drawing an attention in conjunction with patient outcome. The aim of this study was to assess the association of serum biochemical markers with mortality in head trauma patients with decompressive craniotomy. METHODS Ninety six patients with acute subdural hematoma underwent decompressive craniectomy between January 2014 and December 2015. The clinical data and laboratory variables of these patients were recorded and analyzed retrospectively. The pre-operative and post-operative day (POD) 0, day 1 and day 2 serum variables were measured. These were compared between the survivors and non-survivors. RESULTS The factors of a large amount of intra-operative blood loss, shorter length of intensive care unit stays, and the needs for mechanical ventilation were related with mortality in the patients with decompressive craniectomy. These clinical factors were associated with the physiological derangements of sera. The average difference in serum chloride concentration between the pre-operative and POD 2 measurements (p=0.0192) showed a statistical significance in distinguishing between survivors and non-survivors. The average differences in albumin (p=0.0011) and platelet count (p=0.0004) between the pre-operative and POD 0 measurements suggested to be strong predictors of mortality in decompressive craniectomy. CONCLUSION Isolated values of physiological biomarkers are not sufficient enough to predict in-hospital mortality. This study emphasizes the importance of a combined prognostic model of the differences in the pre-operative and post-operative hyperchloremia, thrombocytopenia, and hypoalbuminemia to identify the risk of mortality in decompressive craniecomy.