Outcomes And Relevant Factors Associated With Cardiac Dysfunction In Patients With Traumatic Brain Injury Admitted To Intensive Care Units

Objective:Cardiac dysfunction has been rarely reported in patients with traumatic brain injury(TBI).The study aimed to compare clinical outcomes in patients with normal cardiac function versus cardiac dysfunction after TBI during intensive care unit(ICU)stay,and was to determine whether the cardiac dysfunction was correlated to the outcomes.Moreover,the association of related factors and in-hospital mortality and length of stay(in-hospital and ICU)were investigated.Methods: A retrospective study was conducted from December 2011 to April 2018 on TBI patients admitted for non-cardiac reasons.Patients with TBI were grouped into secondary cardiac dysfunction(n=112)and normal cardiac function(n=160)groups according to the presence of abnormal echocardiography after ICU admission.We compared the clinical characteristics and outcomes between the two groups.Diagnostic performances of age,GCS score,troponin and BNP were analyzed for cardiac function.Univariate and multivariate analyses for influential factors for in-hospital mortality and length of stay were performed.Results:Elevated BNP and troponin levels were found in the subjects with cardiac dysfunction.Patients with cardiac dysfunction had significantly higher mortality(23.21% vs.8.13%),lower cure rate(58.93% vs.83.13%)and longer length of stay in ICU(16.34 vs.10.99)than those without cardiac events.Cardiac dysfunction was an independent predictor of in-hospital mortality(OR 6.66,95% Cl2.39-18.61,p <0.001)and the length of ICU stay(Exp(B)0.132,95% Cl 0.08-0.19,p <0.001)after adjusting confounders.The AUCs of age,elevated troponin and BNP in predicting cardiac dysfunction were 0.705,0.606 and 0.666,respectively.Factors associated with in-hospital mortality was cardiac function(OR = 3.17,95% CI1.44-6.95,p = 0.004).Factors mainly associated with length of stay in hospital were age(Exp(B)?=0.36,95% CI-0.01-0.71,p =0.043),GCS score(Exp(B)?=-1.97,95% CI-3.16-0.78,p <0.001),and use of mechanical ventilation(Exp(B)?=21.89,95% CI 4.59-39.18,p =0.013).GCS score(Exp(B)?=-1.49,95% CI-2.09~-0.89,p <0.001),and use of vasopressor(Exp(B)?=-33.42,95% CI-60.97~-0.86,p =0.018)were related factors associated with length of ICU stay.Conclusions:Cardiac dysfunction in context of TBI have a negative impact on clinical outcomes,and it is an independent predictor for decreased cure rate and longer length of in-hospital stay.