Fatores associados à mortalidade intra-hospitalar no trauma cranioencefálico grave: uma revisão sistemática

Abstract

Introduction: Traumatic Brain Injury (TBI) is one of the leading causes of unfavorable outcomes and deaths, representing a public health problem in the global health context. Worldwide, it is estimated that more than 68 million people suffer from TBI in low- and middleincome countries, driving the emergence of measures and actions that enable the identification of prognostic and risk factors associated with death and disability. Objective: To identify the factors associated with in-hospital mortality in patients who suffered severe TBI. Methodology: This is a systematic literature review of prognostic factors. The protocol of this systematic review was previously registered in PROSPERO (CRD4202235029), ensuring methodological transparency and preventing duplication of studies. Our study was guided by the PRISMA tool and the Cochrane Handbook for reviews of prognostic factors. The databases analyzed were: EMBASE, Scopus, Web of Science, BVS, PubMed/Medline, and Google Scholar. The inclusion criteria of our study were: publications in English that answer the research question, with no time restriction, available in the mentioned databases, that investigate and report in their results the factors associated with mortality in patients with severe TBI, cohort and case-control studies, involving adults aged 18 to 65 years, and outcomes addressing risk factors for mortality after severe TBI with multivariate analysis data using risk ratio or odds ratio. All abstracts and articles included for analysis were independently assessed by two reviewers, with a third reviewer consulted to resolve inconsistencies. Results: Fifteen articles were included in the final sample. After analysis, the main factors associated with mortality in patients with severe TBI were identified as advanced age, intracranial hypertension, inflammatory biomarkers (NCLR4, MMP-9, NSE, and IL-9), hyperglycemia, hemoglobin and hypochloremia during hospitalization, as well as low scores on the Glasgow Coma Scale (≤ 8 points), FOUR scale, APACHE II, and AIS. Conclusion: It is concluded that severe traumatic brain injury and its relationship with increased morbidity and mortality is multifactorial.