Objective To investigate the dynamic changes and clinical significance of forkhead protein O3a (FOXO3a) and triggering receptor expressed on myeloid cells-1 (TREM-1) in serum of patients with severe craniocerebral injury.

Methods A total of 82 patients with severe craniocerebral injury were selected as the observation group, and 80 healthy volunteers in the same period were selected as the control group.Enzyme-linked immunosorbent assay was used to detect the serum levels of FOXO3a and TREM-1.According to the Glasgow coma scale 28 days after injury, the patient was divided into a good prognosis group (n=60) and a poor prognosis group (n=22).The serum levels of FOXO3a and TREM-1 between the observation group patients on the first day after diagnosis and the control group subjects on the day of physical examination were compared; the dynamic changes of serum levels of FOXO3a and TREM-1 in patients with severe craniocerebral injury were observed; the clinical data of patients with severe craniocerebral injury with different prognoses were compared; the predictive value of serum levels of FOXO3a and TREM-1 for the prognosis of patients with severe craniocerebral injury was analyzed.

Results Compared with the subjects in the control group, the serum level of FOXO3a of patients in the observation group was significantly decreased on the first day after diagnosis (P < 0.01), and the level of TREM-1 level was significantly increased (P < 0.01).On the third day after diagnosis, the serum level of FOXO3a in patients with severe craniocerebral injury was higher than that on the first and seventh day after diagnosis (P < 0.05), and the level of TREM-1 was lower than that on the first and seventh days after diagnosis (P < 0.05).Compared with the good prognosis group, the serum level of FOXO3a in patients with severe craniocerebral injury in the poor prognosis group on the first, third, and seventh day after diagnosis was significantly decreased (P < 0.01), and the level of TREM-1 level was significantly increased (P < 0.01).On the third day after diagnosis, the serum level of FOXO3a in patients with good and poor prognosis was higher than those on the first and seventh day after diagnosis, while the level of TREM-1 was lower than that on the first and seventh day after diagnosis (P < 0.05).ROC curve analysis showed that on the third day after diagnosis, the AUC of FOXO3a, TREM-1, and their combined prediction for prognosis in patients with severe craniocerebral injury were 0.776, 0.762, 0.832, respectively, and the combined predictive value of the two was better than that of FOXO3a and TREM-1 alone (Z=1.94, 1.87, P < 0.05).

Conclusions The serum level of FOXO3a in patients with severe craniocerebral injury increases first and then decreases with time, and the serum level of TREM-1 decreases first and then increases with time, which are related to the prognosis of patients, and the combination of the two can better predict the prognosis of patients with severe craniocerebral injury.