Development and validation of a risk stratification tool for 28-day mortality based on D-dimer to platelet ratio in moderate-to -severe traumatic brain injury: a retrospective cohort study.

Background: Moderate-to-severe traumatic brain injury (msTBI) is associated with significant mortality. Post-injury coagulopathy, involving elevated fibrinolysis (reflected by D-dimer) and platelet consumption (reflected by platelet count), contributes to acute neurological deterioration and poor outcomes. This study evaluated the potential association of the D-dimer to platelet ratio (DPR) with 28-day all-cause mortality and explored its link to early neurological progression as a mechanistic validation in patients with msTBI. Methods: This retrospective, single-center cohort study included 340 patients with msTBI. Patients were divided into training ( Results: In the multivariable Cox regression, Glasgow Coma Scale (GCS), admission blood glucose (ABG), and DPR (per 1 SD increase) (HR: 1.558, 95% CI: 1.291-1.881, Conclusion: Admission DPR is an independent risk marker associated with both acute neurological progression and 28-day mortality in patients with msTBI. The DPR-B tool, incorporating GCS, ABG, and DPR, offers a potential framework for early risk stratification; however, its clinical generalizability and translational value for guiding therapeutic interventions warrant further validation in prospective studies using more proximal, pathophysiologically relevant outcomes.