Impact of epidemiological and nutritional factors on outcomes following traumatic brain injury in a prospective cohort study

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Abstract
Traumatic brain injury (TBI) continues to be one of the world's top causes of mortality and long-term disability. It is a severe and frequently fatal disorder. Patients with traumatic brain injury (TBI) not only sustain neurological impairment but also undergo significant metabolic changes and psychological stress, which may affect their ability to recover. The purpose of this study was to investigate the nutritional determinants and epidemiological trends linked to outcomes in traumatic brain injury patients. This prospective cohort study was carried out at the Imam Reza Hospital's Trauma Department in Tabriz, Iran. Over the course of six months, 520 patients with moderate-to-severe traumatic brain injury were consecutively enrolled, and they were monitored for one month following their release from the hospital. Clinical findings, radiographic results, laboratory data, therapies, outcomes, mechanisms of injury, and demographics were all methodically documented. BMI and serum albumin levels were used at discharge and one-month follow-up to evaluate nutritional status. The Impact of Event Scale (IES) and the Hospital Anxiety and Depression Scale (HADS) were used to assess psychological status. Descriptive techniques, correlation analyses, paired comparisons, and receiver operating characteristic (ROC) curve analysis were among the statistical techniques used to evaluate the standalone discriminatory ability of psychological and nutritional variables. The mean age of the patients was 32.49 ± 13.78 years, and 71.7% were male. Nearly 75% of injuries were caused by falls, making them the most frequent cause. In total, 51.2% of patients passed away while in the hospital, whereas 48.8% of patients survived discharge. Discharge and one-month Glasgow Coma Scale (GCS) scores demonstrated a substantial correlation with outcome (p < 0.001), and neurological severity was strongly associated with survival. Survival, neurological improvement, and psychological distress did not significantly correlate with either discharge or follow-up BMI. Additionally, there was no significant correlation between serum albumin levels and survival, anxiety, depression, or symptoms of post-traumatic stress disorder. BMI, HADS, and IES all showed poor outcome discrimination, and ROC analyses supported their limited standalone discriminatory ability. In this cohort of patients with moderate-to-severe TBI, BMI and serum albumin were not associated with survival or psychological distress and showed limited standalone discriminatory ability for short-term outcomes. These findings suggest that recovery after TBI cannot be adequately characterized by simple nutritional indices alone and support the use of more comprehensive, multidimensional approaches to nutritional and prognostic assessment in TBI survivors.

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