# Serum Nrf2 Levels in Severe Traumatic Brain Injury Patients and Its Significance in Predicting 28‐Day Mortality

## TL;DR

This study found that lower levels of a protein called Nrf2 in the blood of severe brain injury patients are linked to higher chances of dying within 28 days.

## Contribution

The study identifies serum Nrf2 as a potential biomarker for predicting 28-day mortality in severe traumatic brain injury patients.

## Key findings

- Deceased patients had significantly lower serum Nrf2 levels compared to survivors.
- Nrf2 levels showed a negative correlation with inflammatory markers IL-6 and IL-17.
- Serum Nrf2 was independently associated with 28-day mortality in multivariate analysis.

## Abstract

The objective of this study was to examine the levels of serum Nrf2 in patients with severe traumatic brain injury (STBI) and assess its predictive value for 28‐day mortality.

This study prospectively observed 252 patients with STBI who were admitted to our ICU between January 2018 and April 2024. Serum samples were collected within 24 h of admission, and levels of nuclear factor erythroid 2‐related factor 2 (Nrf2) and inflammatory cytokines were measured using ELISA. Additionally, the mortality rate within 28 days after admission to the ICU was recorded.

In this prospective observational study, based on the 28‐day mortality after admission to the ICU, the patients were categorized into two groups based on their outcomes: the survival group (n = 184) and the deceased group (n = 68). Compared to the survival group, the deceased group exhibited lower serum Nrf2 levels and higher IL‐6 and IL‐17 levels. Spearman correlation analysis revealed a negative correlation between serum Nrf2 levels and serum IL‐6, IL‐1β, and IL‐17 levels, while a positive correlation was observed between serum Nrf2 levels and GCS scores. The ROC curve indicated that serum Nrf2 could be used to predict the 28‐day mortality in patients with STBI. Finally, multivariate logistic regression analysis showed that serum Nrf2, IL‐6, and IL‐17 levels were independently associated with 28‐day mortality in STBI patients.

In conclusion, we observed significantly lower serum Nrf2 levels in deceased STBI patients compared to the survival group. Additionally, Nrf2 could be used as a potential marker to predict 28‐day mortality in STBI patients.

This study analyzed 252 patients with severe traumatic brain injury and found that serum Nrf2 levels were significantly lower in those who died within 28 days. These findings suggest that serum Nrf2 may serve as a valuable prognostic biomarker for predicting short‐term mortality in patients with severe traumatic brain injury.