Serum Nrf2 Levels in Severe Traumatic Brain Injury Patients and Its Significance in Predicting 28-Day Mortality.

OBJECTIVE: The objective of this study was to examine the levels of serum Nrf2 in patients with severe traumatic brain injury (STBI) and assess its predictive value for 28-day mortality. METHODS: This study prospectively observed 252 patients with STBI who were admitted to our ICU between January 2018 and April 2024. Serum samples were collected within 24 h of admission, and levels of nuclear factor erythroid 2-related factor 2 (Nrf2) and inflammatory cytokines were measured using ELISA. Additionally, the mortality rate within 28 days after admission to the ICU was recorded. RESULTS: In this prospective observational study, based on the 28-day mortality after admission to the ICU, the patients were categorized into two groups based on their outcomes: the survival group (n = 184) and the deceased group (n = 68). Compared to the survival group, the deceased group exhibited lower serum Nrf2 levels and higher IL-6 and IL-17 levels. Spearman correlation analysis revealed a negative correlation between serum Nrf2 levels and serum IL-6, IL-1β, and IL-17 levels, while a positive correlation was observed between serum Nrf2 levels and GCS scores. The ROC curve indicated that serum Nrf2 could be used to predict the 28-day mortality in patients with STBI. Finally, multivariate logistic regression analysis showed that serum Nrf2, IL-6, and IL-17 levels were independently associated with 28-day mortality in STBI patients. CONCLUSION: In conclusion, we observed significantly lower serum Nrf2 levels in deceased STBI patients compared to the survival group. Additionally, Nrf2 could be used as a potential marker to predict 28-day mortality in STBI patients.