الفهرس 
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Abstract
Head injury is a major public health problem and this so called ‘silent epidemic’. It is a major cause of morbidity, mortality and disability in the population under 40–45 years of age[261].
Each year in the United States about two million people suffer a TBI and about 500,000 are hospitalized.The application of biomarkers could lead to expeditious diagnosis in the case of sedated, unconscious, or polytraumatized patients even before the application of neuroimaging techniques[61].
Resistin is a newly discovered adipokine that has been suggested to play a role in the development of insulin resistance and obesity[241].It is evidenced that resistin could be produced by the brain and pituitary gland[25]. In the patients with ischemic stroke, high plasma resistin level has been associated with mortality and disability[30].
This descriptive study was performed to evaluate serum resistin level as a predictor of outcome in ICU patients with traumatic head injury to improve outcome among traumatic head - injured patients.
This study was achieved on 48 patients with severe head injury admitted to ICU included those with history of traumatic head injury justified by CCT and GCS < 8/15 on admission. The study included the patients of the age group between 18 - 60 years and both sexes .With exclusion of the following , pregnancy, obesity (BMI >30), previous neurological diseases ,internal haemorrahge, either abdominal or thoracic, diabetes mellitus , hypertension , chronic heart or lung disease, renal impairment and liver cirrhosis.
After patient assessment through history,examination and investigations, management was introduced in ICU included medical( and surgical treatment if needed). All patients within inclusion criteria were taken.
Computed tomography (CT) scans were performed before ICU admission, after 48 hours and on the 5th day and if neurological deterioration noticed. Venous blood sample (about 3cm3) was drawn for complete blood count, coagulation profile, liver function, kidney function tests, serum electrolytes and random blood sugar. Another venous blood sample (about 3cm3) was drawn for serum level of resistin protein. Also arterial blood gas sample (about 2cm3) was taken. All samples were taken on admission and every day till time of discharge from ICU except resistin as it was drawn only on admission,3rd and 5th days. Then analysis was done by the specific” resistin protein kits ”using enzyme-linked immunosorbent assay (ELISA).
On discharge, patients were neurologically reassessed and the ICU length of stay was recorded.
In this study the mean age of the studied patients was 32.3 ± 8.1 years. Half of the studied patients were in age group 20 – 30 years old. Most of the studied patients were males (91.7%).The mean of BMI of studied patients was 25.4 ± 2.7. Eight patients (16.7%) have signs of lateralization. Pupils were reactive to light bilaterally among 33.3% of patients and unilaterally among 58.4% while pupils were not reactive among 4 patients. No one was suffering from hypoxia. Mean arterial BP significantly increased on day 3 compared to on admission. This study demonstrated that the mean end tidal CO2 was within range of normocapnia. Mean random blood sugar showed hyperglycemia among studied patients. Also the mean GCS on admission was 6/15 with median of 5.5/15. In this study we also found that the most common CT findings were subdural hemorrhage (41.7%), brain edema (33.3%), subarachnoid hemorrhage (25%) and brain contusions (25%). Most of the studied patients showed multiple findings on CT (58.3%).
Also there was significant rise in mean serum resistin level on day 3 and then reduced on day 5.
In our study the mean random blood sugar was 204.25 gm/dl with range from 130 to 300 gm/dl on admission with significant decrease on day 3 and day 5 compared to on admission, this was due to good control of RBS in order to decrease the effect of hyperglycemia on patients.Also regarding to temperature there was significantly decrease on day 3 and day 5 compared to on admission due to good control of hyperthermia to decrease its effect on patients.
This study showed that after 14 days of follow up in ICU according to Glasgow outcome scale (GOS), mortality was reported among 12 cases (25%), severe disability among 20 patients (41.7%) and good recovery among 25% of patients. The remaining cases (8.3%) had persistent vegetative state. The main cause of death was brain stem death with hemodynamic instability to whom adrenaline support was added from the 3rd day till death. About four cases with GCS 7/10T (subarachnoid hemorrhage ) on day 5 were improved, extubated and discharged with minimal disability with GCS 10/15 . Also only five cases with GCS 6/10T (post epidural evacuation ) on day 5 were improved ,extubated and discharged with minimal disability with GCS 10/15 .About three cases showed good recovery with GCS 15/15 (post subdural evacuation) . The remaining cases were tracheostomized then discharged from ICU.
In this study we reported that patients with poor outcome (defined as vegetative or disability state) had significantly older age ,lower GCS on admission and higher baseline resistin level compared to patients with good recovery.Seventy five % of poor outcome group have unilateral irreactive pupil versus 33.3% of good recovery group . RBS was significantly higher among patients with poor outcome.
Also multiple logistic regression model had shown that GCS on admission <7/15, unilateral irreactive pupil and baseline resistin level > 0.527 are significant predictors of poor outcome (vegetative state and disability) with OR: 0.73, 1.3 and 1.5 respectively.According to ROC curve we discovered that a value of resistin level on admission of TBI patient to ICU > 0.618 ng/ml was a significant predictor for two weeks mortality with sensitivity of 100%, specificity of 77.8%, PPV of 60% and NPV of 100%.
We concluded that plasma resistin level was highly associated with GCS as low score on the GCS upon admission is strongly correlated with a high plasma resistin level. We concluded that resistin could possibly used as a novel biomarker in TBI as adjuvant prognostic tool to predict poor outcome. Resistin is more valid prognostic modality that could spare unnecessary brain CT if applied.