ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurotrauma
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1669136
Association of hemoglobin variation and hospital mortality in patients with traumatic brain injury at high altitude
Provisionally accepted
- 1People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture, Aba, China
- 2sichuan cancer hospital, 9623.1030851, China
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ABSTRACT Backgroud: Traumatic brain injury (TBI) ranks among the leading causes of death worldwide. However, the association between hemoglobin variation (ΔHb) and hospital mortality in TBI patients at high altitude remains uninvestigated. 2 Method: This retrospective cohort study was conducted from January 2020 to March 2025 in the Tibetan Plateau region, enrolling 191 patients who resided at an average altitude of 3000 meters. ΔHb (peak Hb-nadir Hb) during the hospitalization, related covariates and hospital mortality were collected. Backward stepwise multivariable logistic regression was used to select key variables. The nonlinear relationship between ΔHb and mortality was investigated using the multivariable fractional polynomial (MFP) method. The threshold effects of ΔHb were explored through two-piecewise logistic regression models. Results: Logistic regression showed that ΔHb was independently and significantly associated with hospital mortality (OR=1.08, 95%CI: 1.02-1.15, P=0.005) after adustment for nadir Hb, diffuse axonal injury and GCS (Glasgow coma scale) score. A cubic nonlinear relationship between ΔHb and hospital mortality was revealed (P for nonlinearity=0.010), with an inflection point at 19.8 g/L. Additionally, an interaction effect between ΔHb and GCS score was found (P=0.035). Conclusions: In the clinical management of high-altitude TBI patients, our findings suggest that those with a ΔHb greater than 20 g/L, and a substantially elevated ΔHb and a low GCS score have an increased risk of mortality. A study investigating interventional strategies aimed at reducing ΔHb in TBI patients is warranted.
Keywords: Traumatic Brain Injury, hemoglobin variation, Mortality, Hemoglobin, Glasgow Coma Scale (GCS)
Received: 19 Jul 2025; Accepted: 10 Sep 2025.
Copyright: © 2025 Wang, Zhang and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhenjun Liu, sichuan cancer hospital, 9623.1030851, China
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