Medical Journal of the Islamic Republic Of Iran

en Evaluating the Efficacy of Longitudinal Coagulation Biomarkers to Predict in-Hospital Death in Comatose TBI Patients: A Time-Dependent Roc Curve Approach Biostatistics and Epidemiology Biostatistics and Epidemiology Original Research Original Research     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.   Blood coagulation disorders, Traumatic Brain Injury, INR, PT, and aPTT, Sensitivity, Specificity 500 508 http://mjiri.iums.ac.ir/browse.php?a_code=A-10-5656-2&slc_lang=en&sid=1 Fatemeh Ebrahimi-nejad sepide.ebra@googlemail.com 200319475328460091728 200319475328460091728 No Biostatistics Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Saeed Oraee-Yazdani saeed.o.yazdani@gmail.com 200319475328460091729 200319475328460091729 No Shohada Tajrish Neurosurgical Center of Excellence, Functional Neurosurgery Research Center, Shohada Tajrish Hospital, Shahid Beheshti, University of Medical Sciences, Tehran, Iran Mohsen Vahedi mohsenvahedi540@gmail.com 200319475328460091730 200319475328460091730 No Biostatistics Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Marzieh Peyravi Dehsorkhi marziehp67@gmail.com 200319475328460091731 200319475328460091731 No Shohada Tajrish Neurosurgical Center of Excellence, Functional Neurosurgery Research Center, Shohada Tajrish Hospital, Shahid Beheshti, University of Medical Sciences, Tehran, Iran Nasrin Hosseini hosseini.n58@gmail.com 200319475328460091732 200319475328460091732 No Neuroscience Research Center, Iran University of Medical Sciences, Tehran, Iran Samaneh Hosseinzadeh Hosseinzadeh.sa@iums.ac.ir 200319475328460091733 200319475328460091733 Yes Biostatistics Department, School of Public Health, Iran University of Medical Sciences, Tehran, Iran