Markevich D.P.1, Marochkov A.V.2, Livinskaya V.A.3
Anesthesiologic management and intensive care of traumatic brain injury and C-reactive protein as a criterion of survival and treatment efficacy of patients
1Mogilev Emergency City Hospital, Mogilev, Republic of Belarus
2Mogilev Regional Hospital, Mogilev, Republic of Belarus
3Belarusian-Russian University, Mogilev, Republic of Belarus
Vestnik VGMU. 2020;19(3):59-68.
Objectives. To determine the changes in the level of serum C-reactive protein (CRP) in the blood serum and the possibility of its use as a criterion to predict the severity and outcome of patients’ treatment with traumatic brain injury (TBI).
Material and methods. CRP was made in 48 operated patients with TBI. Patients were different with respect to the severity of their condition and treatment outcomes. CRP was determined at 7 stages of the study: stage I – until 1-2 hours before surgery, then after surgery: stage II – in 11 (6; 17) hours, stage III – in 35 (29; 40) hours, stage IV – in 60 (52; 65) hours, stage V – in 108 (100; 113) hours, stage VI – in 155 (148; 161) hours, stage VII – after 226 (220; 233) hours.
Results. Significant differences in CRP between groups of patients with severe and moderate TBI were revealed at stages V – VII. At the 5th stage, in patients with severe TBI CRP was 108.8 (103.4; 187.6) mg/l, with a moderate head injury – 38.8 (27.2; 78.5) mg/l, p=0.001. At stage VI, in patients with severe head injury, CRP was 104.8 (90.8; 174.5) mg/l, with a moderate head injury – 10.5 (3.8; 25.9) mg/l, p=0.002. At stage VII, in patients with severe TBI, CRP was 107.1 (83.4; 144.6) mg/l, with a moderate TBI – 11.0 (5.5; 84.5) mg/l, p=0.008. The sensitivity of CRP at stage VII for an unfavorable outcome was 69%, specificity – 80%.
Conclusions. The highest level of CRP in patients with head injury was noted in 60 (52; 65) hours after craniotomy – 110 (90.7;171) mg/l. Significant differences of serum CRP between patients with severe and moderate TBI were revealed on the 5th, 7th and 10th day after surgery. The level of CRP in 108 (100; 113) hours after surgery has a prognostic ability to develop an unfavorable TBI outcome.
Key words: C-reactive protein, traumatic brain injury, anesthesia, neuroanesthesiology.
Financing. To conduct the study the grant sources of the President of the Republic of Belarus were used.
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Information about authors:
Markevich D.P. – head of the anesthesiology and intensive care department, Mogilev Emergency City Hospital,
Marochkov A.V. – Doctor of Medical Sciences, professor, anesthesiologist-resuscitator, the anesthesiology & resuscitation department, Mogilev Regional Hospital,
Livinskaya V.A. – Candidate of Physical and Mathematical Sciences, associate professor of the Chair «Finance & Accounting», Belarusian-Russian University,