Prognostic value of circulating neuron-specific enolase combined with erythrocyte and platelet distribution indices in patients with severe traumatic brain injury.

BACKGROUND: Severe traumatic brain injury (STBI) is associated with high mortality and long-term neurological disability. Early identification of reliable circulating biomarkers may improve prognostic stratification and clinical management. Haematological distribution indices, including red cell distribution width (RDW) and platelet distribution width (PDW), along with neuron-specific enolase (NSE), reflect systemic inflammation, platelet activation, and neuronal injury following traumatic brain injury. However, their combined prognostic value in STBI remains incompletely understood. METHODS: A retrospective study was conducted, including 96 consecutive patients with STBI admitted between March 2020 and March 2023. The GCS score used for rSIG calculation was the first documented admission score before definitive neurosurgical treatment. Treatment was individualised according to injury severity and imaging findings, including conservative management, hematoma evacuation, decompressive craniectomy, ventilatory support, and intensive care when indicated. Peripheral blood levels of RDW, PDW, and serum NSE were measured at admission using automated haematology analysis and enzyme-linked immunosorbent assay. According to the Glasgow Outcome Scale (GOS), evaluated 3 months after injury, patients were classified into a good-prognosis group (n= 46) and a poor-prognosis group (n = 50).