ArticleIn vivo (Athens, Greece)
Clinical and Biochemical Predictors of 30-Day Mortality After Decompressive Craniectomy: A Retrospective Cohort Study.
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Abstract
BACKGROUND/
aimDecompressive craniectomy (DC) is a life-saving intervention performed in patients with severe neurological deterioration; however, early postoperative mortality remains high and reliable biochemical predictors are not well defined. This study aimed to identify early clinical and perioperative biochemical predictors of 30-day mortality in patients undergoing DC. PATIENTS AND
methodsThis single-center retrospective cohort study included 102 patients who underwent DC between 2019 and 2024. Demographic, clinical, radiological, and biochemical parameters including sodium, potassium, hematocrit, international normalized ratio (INR), C-reactive protein (CRP), and neutrophil to lymphocyte ratio (NLR) were analyzed. The primary outcome was 30-day mortality. Univariable analyses were conducted using Chi-square and
resultsThirty-day mortality occurred in 70.6% of patients. In the multivariable model, preoperative INR >1.20 (OR=25.60; 95% CI=1.89-345.82;
conclusionPreoperative INR and discharge NLR are strong independent predictors of early mortality after decompressive craniectomy, while preoperative GCS remains a key indicator of improved survival. These routinely available biochemical markers may enhance postoperative risk stratification and inform clinical decision-making in critically ill neurosurgical patients.
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