Role of early cell-free DNA levels decrease as a predictive marker of fatal outcome after severe traumatic brain injury

► TBI patients exhibit early high cf-DNA levels after trauma. ► cf-DNA levels significantly fall but never reach control values before discharged from the ICU. ► cf-DNA decrease after 24 h differs among patients and may be indicative of patient outcome. ► ROC analysis showed that a cut-off point of 1.95 decrease allows stratification of the patients after TBI. ► cf-DNA levels at 0 and 24 h were significantly lower in patients with minor TBI compared to severe ones