Feasibility of transcription factor EB as a serological metric of poor prognosis following moderate–severe traumatic brain injury: A prospective cohort study

Transcription factor EB (TFEB) is an endogenous protective factor. Here, we sought to discern the possibility of serum TFEB as a prognostic biomarker of moderate-severe traumatic brain injury (msTBI). Serum TFEB levels of 141 patients with msTBI and 70 controls were quantified in this prospective cohort study. Rotterdam computed tomography (CT) classification and Glasgow coma scale (GCS) were considered as the severity metrics. Glasgow outcome scale (GOS) scores of 1 to 3 at 6 months after trauma meant a poor prognosis. The results were analyzed using multivariate analysis. Patients versus controls had a notable reduction of serum TFEB levels. Serum TFEB levels of independent correlation with Rotterdam CT scores and GCS scores were independently relevant to continuous GOS scores and ordinal GOS scores. Serum TFEB levels of linear relation to risk of poor prognosis under restricted cubic spline were independently predictive of poor prognosis. Using receiver operating characteristic curve analysis, serum TFEB levels displayed analogous prognostic predictive ability to Rotterdam CT scores and GCS scores. The constructed model by merging the 3 prognostic independent predictors, that is serum TFEB, Rotterdam CT scores and GCS scores, was pictorially exhibited via the nomogram, and was demonstrated to perform well by adopting several statistical approaches. An obvious decline of serum TFEB levels subsequent to msTBI are firmly related to trauma severity and poor neurological outcomes of patients, reinforcing the clinical meaningfulness of serum TFEB as a prognostic biochemical indicator of msTBI.