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Inpatient Metabolic Panel Trajectories Improve 6-Month Mortality Prognostication after Severe Traumatic Brain Injury
Shawn R Eagle1, Jaeyong Shim2, Mark A MacLean1
1Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Neurotrauma Reports
|August 1, 2026
Summary
Tracking daily metabolic panels like sodium and platelets in the first week after severe traumatic brain injury (sTBI) can improve prognosis. These lab trajectories offer better prediction of 6-month mortality than existing models alone.
Area of Science:
- Neuroscience
- Clinical Medicine
- Biomarkers
Background:
- The International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) model for traumatic brain injury (TBI) uses only hospital admission data.
- Improved prognostic accuracy for severe TBI (sTBI) may be achieved by incorporating updated physiological data beyond initial hospital admission.
- Daily monitoring of clinical metabolic panels in the first week post-sTBI could reveal crucial prognostic information.
Purpose of the Study:
- To evaluate differences in the daily trajectories of clinical metabolic panels (glucose, sodium, platelets, hemoglobin) during the first 7 days following sTBI.
- To compare the prognostic value of these metabolic panel trajectories against the existing IMPACT model for predicting 6-month mortality.
- To determine if incorporating metabolic panel trajectories enhances the prognostic ability for individual sTBI patients.
Main Methods:
- Prospective cohort study of 572 patients with sTBI (Glasgow Coma Scale [GCS] ≤8).
- Daily metabolic panels (glucose, sodium, platelets, hemoglobin) were tracked for the first 7 days post-injury.
- Ordinal mixed-effects models compared daily trajectories between 6-month survivors and nonsurvivors; prognostic value was assessed using area under the curve (AUC) and likelihood ratio tests (LRT).
Main Results:
- Statistically significant differences in the 7-day trajectories of sodium (LRT adj. p < 0.001) and platelets (LRT adj. p = 0.003) were observed between survivors and nonsurvivors.
- Nonsurvivors showed lower odds of higher platelet categories on days 6 and 7 post-injury (OR = 0.27-0.41).
- The IMPACT-biomarker trajectory model (AUC = 0.87) demonstrated improved prognostic ability for 6-month mortality compared to the IMPACT-only model (AUC = 0.85).
Conclusions:
- The daily trajectory of specific metabolic panel labs, particularly sodium and platelets, in the first week post-sTBI provides significant prognostic information.
- Incorporating these metabolic panel trajectories into prognostic models meaningfully improves the prediction of 6-month mortality for individual sTBI patients.
- This approach offers a valuable enhancement to existing prognostic tools for severe traumatic brain injury.
