Abstract Head trauma is one of common injury related mortality and morbidity. Blood biomarkers are valuable tools for the identification and characterization of initial injury and secondary pathological processes for traumatic brain injury (TBI). This study evaluated the performance of a recently developed visfatin and its correlation with other blood circulating biomarkers that reflect specific pathological mechanisms including neuro inflammatory, neuron injury and oxidative damage in moderate to severe TBI patients. Peripheral blood was taken from TBI patients (n = 78) at hospital admission, maximum 6 hours post-injury. Severity and neurological outcome were assessed using the Glasgow Coma Scale (GCS) and blood level of: visfatin, neuron specific enolase (NSE), malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione (GSH). Concentrations of visfatin (28 ± 1.68 μg/L, 25 ± 2.09 μg/L) was significantly higher (p 0.0001) in sever and moderate groups of TBI patients respectively compared to control group (7.62 ± 0.87 μg/L), NSE concentrations also were significantly higher (p 0.0001) in both groups of TBI patients (20.47 ± 3 ng/ml, 13.49 ± 2.66 ng/ml) compared to control group (4.3 ± 0.52 ng/ml), MDA was significantly elevated (p 0.001) in sever TBI patients group (6.88 ± 0.58 μmol/L) compared to control group (5.12 ± 0.76 μmol/L), while SOD (245.12 ± 24.2 U/L, 276.097 ± 30.8 U/L) and GSH (112.07 ± 2.09 μmol/L, 119.26 ± 2.7 μmol/L) were highly significantly decreased (p 0.0001) in TBI patients compared to control group (304.17 ± 27.17 U/L and 151.64 ± 9.9 μmol/L) respectively. Visfatin was positively correlated with NSE and MDA, while there was negative correlation with SOD and GSH. In conclusion blood level of visfatin in correlation with other blood biomarkers can be used for prediction of severity of TBI cases.