Combined citicoline and Cerebrolysin for neuroprotection in traumatic brain injury: a retrospective cohort analysis.

Introduction: Severe traumatic brain injury (sTBI) remains a major cause of long-term disability and mortality worldwide. Beyond the initial mechanical damage, a cascade of secondary injuries involving neuroinflammation, oxidative stress, and excitotoxicity exacerbates neural dysfunction. Neuroprotective agents such as citicoline and Cerebrolysin have shown promise in addressing these complex mechanisms and supporting recovery. This study aimed to evaluate whether a combination therapy of citicoline and Cerebrolysin improves neurological outcomes compared to citicoline monotherapy in patients suffering from sTBI. Methods: A retrospective cohort analysis was conducted at a single university hospital. Patients with sTBI treated between 2012 and 2021 were included. Two cohorts were matched based on a validated prognostic scoring system to ensure comparability. One group received citicoline monotherapy, while the other received a combination of citicoline and Cerebrolysin. The primary endpoint was neurological function 6 months after injury. Secondary outcomes included survival and duration of stay in the intensive care unit and hospital. Results: Eighty patients were analyzed. While there was no statistically significant difference between the two groups in neurological function or mortality at 6 months, patients receiving the combination therapy showed a tendency toward better neurological outcomes. Notably, this group also exhibited more severe baseline injury profiles, which may have influenced the results. Conclusion: Combined treatment with citicoline and Cerebrolysin may offer additional benefits for neurological recovery in patients with severe traumatic brain injury. Although statistical significance was not reached, the observed trend supports the need for further prospective, controlled studies to explore potential therapeutic advantages.