Opportunities of personalized prediction of lethal outcome in patients with brain contusion

   The purpose – to develop personalized (genetic) criteria for predicting death in patients with cerebral contusion.

   Materials and methods. 96 young patients (according to WHO classification) with brain contusion (TBI) of II and III severity were examined. Control group - 100 practically healthy residents of the same sex and age. The first group (n = 86) consisted of patients with a favorable outcome of brain contusion (recovery) at the age of 30.0 [26; 34] years. The second group (n = 10) included patients with an unfavorable outcome (st. letalis) of TBI (mean age 31.0 [27.0; 34.5] years). Patients with other forms of TBI, any acute and/or chronic comorbidity, and females were excluded from the study. Clinical, laboratory (gene polymorphism: FII-20210(G > A), FV-1691(G > A), FVII-10976(G > A), FGB-455(G > A), MTHFR-677(C > T), MTRR-66(A > G), PAI-1(5G > 4G), TLR2-753(Arg > Gln) and TLR4-299(Asp > Gly), cytokine content: TNFα, IL-1β, IL-4, IL-10; lymphocytic-platelet adhesion, INR and D-dimers) and instrumental (craniography, computed tomography) studies were carried out at the inpatient stage of treatment (material was taken for the study on the 3^rd day after injury). Statistical processing of the study results was carried out using the IBM SPSS Statistics Version 25.0 software package.

   Results. Based on binary logistic regression, the most informative indicators were included in the equation (polymorphism of the FII-20210(G > A), MTRR-66(A > G), PAI-1(5G > 4G) and TLR4-299( Asp > Gly)) and their significance in the structure of the model is determined. The sensitivity of the developed prognostic model is 1.0, the specificity is 0.78, the accuracy is 0.8; the area under the ROC curve is 0.91 (95 % CI = 0.84–0.97); p < 0.001.

   Conclusion. Determination of the genetic polymorphism of the FII-20210(G > A), MTRR-66(A > G), PAI-1(5G > 4G), and TLR4-299(Asp > Gly) genes in patients with severe UGM may allow timely determination of stratification the risk of an unfavorable outcome, which will assist in the development of treatment tactics for this group of patients.

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