Impact of intracranial pressure on the prognosis of patients with severe traumatic brain injury undergoing decompressive craniectomy

Lu Yanping; Wang Jun; Pan Qin; Ma Linwei

doi:10.11850/j.issn.1009-122X.2025.06.005

Abstract：Objective To investigate the impact of intracranial pressure(ICP)on the prognosis of patients with severe traumatic brain injury(sTBI)undergoing decompressive craniectomy.Methods The clinical data of 82 patients with sTBI were analyzed retrospectively,who underwent decompressive craniectomy.All patients received pre-and postoperative ICP monitoring.Based on the Glasgow Outcome Scale(GOS)scores at 6 months postoperatively,patients were divided into a good prognosis group(GOS≥4)and a poor prognosis group(GOS≤3).Clinical data were compared between the two groups,and multivariate logistic regression analysis and receiver operating characteristic(ROC)curve analysis were performed to evaluate the impact of ICP on patient prognosis.Additionally,differences in ICP levels among patients with different poor prognostic statuses(death,vegetative state,severe disability)and the predictive value of ICP for these outcomes were analyzed.Results Among the 82 sTBI patients,42 had poor prognosis(poor prognosis group),including 10 deaths,12 vegetative states,and 20 severe disabilities;40 had a favorable prognosis(good prognosis group),including 14 mild disabilities and 26 good recoveries.The poor prognosis group exhibited significantly higher intracranial hematoma volume,initial ICP,and postoperative ICP compared to the good prognosis group(all P<0.05).Multivariate logistic regression analysis revealed that intracranial hematoma volume(OR=1.459,95%CI:1.112-1.913),initial ICP(OR=1.260,95%CI:1.083-1.466),and postoperative ICP(OR=1.752,95%CI:1.228-2.501)were risk factors for a poor prognosis in sTBI patients(all P<0.05).Among patients with poor prognosis,significant differences were found in initial and postoperative ICP levels between those who died,were in a vegetative state,or had severe disability(all P<0.05).ROC curve analysis demonstrated that postoperative ICP had the highest area under the curve(AUC)for predicting a poor prognosis in sTBI patients(AUC=0.908,95%CI:0.823-0.960),with a specificity of 92.50%and a sensitivity of 76.19%.Conclusion Initial and postoperative ICP are influential factors for the prognosis of sTBI patients undergoing decompressive craniectomy.Elevated initial ICP and sustained postoperative ICP increases are indicative of a poorer prognosis and demonstrate high predictive value for patient mortality.