Medical Journal of The Islamic Republic of Iran (MJIRI)
Iran University of Medical Sciences
Sun, Jul 27, 2025
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Volume 39, Issue 1 (1-2025)
Med J Islam Repub Iran 2025 |
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Ebrahimi-nejad F, Oraee-Yazdani S, Vahedi M, Peyravi Dehsorkhi M, Hosseini N, Hosseinzadeh S. Evaluating the Efficacy of Longitudinal Coagulation Biomarkers to Predict in-Hospital Death in Comatose TBI Patients: A Time-Dependent Roc Curve Approach. Med J Islam Repub Iran 2025; 39 (1) :500-508
URL: http://mjiri.iums.ac.ir/article-1-9505-en.html
URL: http://mjiri.iums.ac.ir/article-1-9505-en.html
Fatemeh Ebrahimi-nejad 
, Saeed Oraee-Yazdani , Mohsen Vahedi , Marzieh Peyravi Dehsorkhi , Nasrin Hosseini , Samaneh Hosseinzadeh
, Saeed Oraee-Yazdani , Mohsen Vahedi , Marzieh Peyravi Dehsorkhi , Nasrin Hosseini , Samaneh Hosseinzadeh
Biostatistics Department, School of Public Health, Iran University of Medical Sciences, Tehran, Iran , Hosseinzadeh.sa@iums.ac.ir
Abstract: (125 Views)
Background: Coagulopathy is a significant risk factor for in-hospital mortality in patients with traumatic brain injury (TBI). Timely monitoring of coagulation biomarkers (CB) may be crucial for predicting TBI patient prognosis. The objective of this study was to assess the time-dependent accuracy of conventional CB in predicting TBI patient outcomes using an ROC curve based on a joint longitudinal and survival data analysis.
Methods: A retrospective cohort study was conducted on 132 out of 604 TBI patients admitted to Shohada-E-Tajrish Hospital in Tehran, Iran, between 2018 and 2020. CB (INR, PT, and aPTT) every 24 hours, and patient outcomes (death or survival) up to 10 days after admission were recorded. After choosing the best joint model longitudinal and survival data, the time-dependent ROC curve analysis was used, and the AUC, sensitivity, and specificity values were calculated in R 4.1.0.
Results: In this study, non-surviving TBI patients had significantly higher mean aPTT, PT, and INR values than survivors. In addition, aPTT demonstrated the strongest time-dependent predictive power (AUC>0.7) for up to the fourth day after admission, while PT and INR had AUC>0.7 for up to the third day after admission.
Conclusion: This study highlights that conventional coagulation biomarkers (aPTT, PT, and INR) demonstrate significant time-dependent efficacy in predicting in-hospital mortality in comatose TBI patients within the first three days of admission. Early recognition and proper management of coagulopathy are essential to improve outcomes and reduce morbidity and mortality in these patients during three days of admission.
Methods: A retrospective cohort study was conducted on 132 out of 604 TBI patients admitted to Shohada-E-Tajrish Hospital in Tehran, Iran, between 2018 and 2020. CB (INR, PT, and aPTT) every 24 hours, and patient outcomes (death or survival) up to 10 days after admission were recorded. After choosing the best joint model longitudinal and survival data, the time-dependent ROC curve analysis was used, and the AUC, sensitivity, and specificity values were calculated in R 4.1.0.
Results: In this study, non-surviving TBI patients had significantly higher mean aPTT, PT, and INR values than survivors. In addition, aPTT demonstrated the strongest time-dependent predictive power (AUC>0.7) for up to the fourth day after admission, while PT and INR had AUC>0.7 for up to the third day after admission.
Conclusion: This study highlights that conventional coagulation biomarkers (aPTT, PT, and INR) demonstrate significant time-dependent efficacy in predicting in-hospital mortality in comatose TBI patients within the first three days of admission. Early recognition and proper management of coagulopathy are essential to improve outcomes and reduce morbidity and mortality in these patients during three days of admission.
Keywords: Blood coagulation disorders, Traumatic Brain Injury, INR, PT, and aPTT, Sensitivity, Specificity
Type of Study: Original Research |
Subject:
Biostatistics and Epidemiology
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