Hepatic response score and its association with radiological features and neurological recovery in traumatic brain injury: A retrospective cohort study

Objective: To develop a principal component analysis (PCA)-derived hepatic response factor and assess its association with radiological features and neurological recovery after traumatic brain injury (TBI). Methodology: This retrospective observational cohort study was conducted at the Department of Neurosurgery, Unit-I, Punjab Institute of Neurosciences, Lahore, Pakistan, involving patients with TBI who were on enteral nutrition between January 2026 and May 2026. Data regarding patient clinical characteristics, radiological features, and neurological outcomes were collected from patient records. Data were analyzed using the Statistical Package for the Social Sciences (SPSS), version 29. After descriptive analysis, principal component analysis was performed to identify latent hepatic response dimensions to construct a PCA-derived hepatic response factor. Results: A total of 56 patients suffering from TBI were included in the study. The mean age of study participants was 34.9±16.6 years, with male predominance (78.6%; 44) males. The mean total bilirubin level was 0.91±0.43, the mean AST value was 39.1±16.9, and ALT was 38.6±15.5. Spearman’s correlation analysis revealed a significant positive correlation of PCA-derived hepatic response factor with midline shift on CT (r=0.294, p=0.028) and Rotterdam CT severity score (r=0.406, p=0.002). Higher PCA-derived hepatic response factor was associated with greater radiological severity in TBI when graded according to Marshal classification and Rotterdam CT grading system after adjustment for age, gender and GCS at admission (β= 0.848, adjusted OR:2.33, 95% CI: 1.01-5.38, p = 0.046) and β= 0.850, adjusted OR: 2.340, 95% CI: 1.25-4.39, p = 0.008). Conclusion: An early PCA-derived hepatic response factor developed through ALT, AST, and bilirubin levels obtained within 24 hours of injury is associated with significant structural injury severity in TBI in terms of radiological features, though the PCA-derived hepatic response factor is not directly associated with neurological outcomes.