Abstract Details

Title Prognostic Utility of Routine Blood Markers in a Neuro-ICU Cohort: A Retrospective Analysis in a Resource Limited Setting

Topic Neuro Trauma and Critical Care

Presentation(s) P8 - Poster Session 8 (11:45 AM-12:45 PM)

Poster/Presentation
Number 18-008

Objective To determine whether routine admission blood markers provide incremental prognostic value over a pragmatic, composite imaging interpretation for adverse outcomes in a neuro-ICU cohort from a low- and middle-income country (LMIC).

Background

Acute neurological illnesses such as traumatic brain injury (TBI) and stroke are leading causes of death and disability, with a disproportionately high burden in LMICs. As advanced biomarkers are often inaccessible, this study evaluates routine low-cost laboratories (e.g., neutrophil percentage, albumin, HbA1c/EAG) alongside imaging which can refine early risk assessment, particularly where baseline under-nutrition is prevalent and may influence outcome.

Design/Methods

This retrospective, single-center proof-of-concept study included consecutive neuro-ICU admissions with mixed etiologies. Predictors comprised a four-level composite imaging score (very low/low/moderate/high mortality risk) and admission laboratories (neutrophil %, albumin, total leukocyte count, HbA1c, estimated average glucose, NLR, PLR, CONUT and SHR). Outcomes were ICU death, poor disposition (death or DAMA), and early death (≤7 days). Penalized logistic regression with 5-fold cross-validation compared Imaging-only versus Imaging+lab models, summarized by mean AUROC and ΔAUC.

Results

Ninety-five patients contributed to at least one endpoint. Imaging-only AUCs were 0.446 for early death, 0.589 for death, and 0.572 for poor disposition. Adding neutrophil percentage markedly improved early-death discrimination to AUC 0.837 (ΔAUC +0.391, N=94); albumin provided a moderate gain to AUC 0.621 (ΔAUC +0.175, N=93). For death, HbA1c/EAG modestly increased AUC to 0.648 (ΔAUC +0.058, N=94). No laboratory improved the poor-disposition endpoint. Exploratory analyses showed SHR, NLR, PLR, and CONUT had limited discrimination for these outcomes in this cohort.

Conclusions In a resource-limited neuro-ICU, neutrophil percentage - a universally available test - provides substantial incremental value over a composite imaging interpretation for predicting early death, with albumin offering moderate benefit and HbA1c/EAG modestly improving overall mortality models. Integrating these low-cost tests with imaging may enhance early triage and warrants prospective multicenter validation in similar LMIC settings.

Authors/Disclosures
Ethel Shiju, MBBS, MBBS student PRESENTER	Miss Shiju has nothing to disclose.
Malavika Rudrakumar (St. John's medical college)	Miss Rudrakumar has nothing to disclose.
Mathangi Krishnakumar, MD	Dr. Krishnakumar has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for Dr Klinisch Research. The institution of Dr. Krishnakumar has received research support from Indian Council of Medical research.
Nalina P. Sahayaraj, MBBS	Miss Sahayaraj has nothing to disclose.