Univariate comparison of performance of different cerebrovascular reactivity indices for outcome association in adult TBI

• Verfasst von: Zeiler, Frederick A. [VerfasserIn]
• Verfasst von: Sakowitz, Oliver [VerfasserIn]
• Verfasst von: Younsi, Alexander [VerfasserIn]
• Titel: Univariate comparison of performance of different cerebrovascular reactivity indices for outcome association in adult TBI
• Titelzusatz: a CENTER-TBI study
• Körperschaft: CENTER-TBI [VerfasserIn]
• Verf.angabe: Frederick A. Zeiler, Ari Ercole, Manuel Cabeleira, Tommaso Zoerle, Nino Stocchetti, David K. Menon, Peter Smielewski, Marek Czosnyka, Audny Anke, Ronny Beer, Bo-Michael Bellander, Andras Buki, Giorgio Chevallard, Arturo Chieregato, Giuseppe Citerio, Endre Czeiter, Bart Depreitere, George Eapen, Shirin Frisvold, Raimund Helbok, Stefan Jankowski, Daniel Kondziella, Lars-Owe Koskinen, Geert Meyfroidt, Kirsten Moeller, David Nelson, Anna Piippo-Karjalainen, Andreea Radoi, Arminas Ragauskas, Rahul Raj, Jonathan Rhodes, Saulius Rocka, Rolf Rossaint, Juan Sahuquillo, Oliver Sakowitz, Ana Stevanovic, Nina Sundström, Riikka Takala, Tomas Tamosuitis, Olli Tenovuo, Peter Vajkoczy, Alessia Vargiolu, Rimantas Vilcinis, Stefa Wolf, Alexander Younsi, CENTER-TBI High Resolution Sub-Study Participants and Investigators
• E-Jahr: 2019
• Jahr: 15 March 2019
• Umfang: 11 S.
• Fussnoten: Gesehen am 29.10.2019
• Titel Quelle: Enthalten in: Acta neurochirurgica
• Ort Quelle: Wien [u.a.] : Springer, 1950
• Jahr Quelle: 2019
• Band/Heft Quelle: 161(2019), 6, Seite 1217-1227
• ISSN Quelle: 0942-0940
• DOI: doi:10.1007/s00701-019-03844-1
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Autoregulation
• Sach-SW: Cerebrovascular reactivity
• Sach-SW: ICP indices
• Sach-SW: Outcome analysis
• K10plus-PPN: 1680608282

Abstract

BackgroundMonitoring cerebrovascular reactivity in adult traumatic brain injury (TBI) has been linked to global patient outcome. Three intra-cranial pressure (ICP)-derived indices have been described. It is unknown which index is superior for outcome association in TBI outside previous single-center evaluations. The goal of this study is to evaluate indices for 6- to 12-month outcome association using uniform data harvested in multiple centers.MethodsUsing the prospectively collected data from the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study, the following indices of cerebrovascular reactivity were derived: PRx (correlation between ICP and mean arterial pressure (MAP)), PAx (correlation between pulse amplitude of ICP (AMP) and MAP), and RAC (correlation between AMP and cerebral perfusion pressure (CPP)). Univariate logistic regression models were created to assess the association between vascular reactivity indices with global dichotomized outcome at 6 to 12 months, as assessed by Glasgow Outcome Score-Extended (GOSE). Models were compared via area under the receiver operating curve (AUC) and Delong’s test.ResultsTwo separate patient groups from this cohort were assessed: the total population with available data (n = 204) and only those without decompressive craniectomy (n = 159), with identical results. PRx, PAx, and RAC perform similar in outcome association for both dichotomized outcomes, alive/dead and favorable/unfavorable, with RAC trending towards higher AUC values. There were statistically higher mean values for the index, % time above threshold, and hourly dose above threshold for each of PRx, PAx, and RAC in those patients with poor outcomes.ConclusionsPRx, PAx, and RAC appear similar in their associations with 6- to 12-month outcome in moderate/severe adult TBI, with RAC showing tendency to achieve stronger associations. Further work is required to determine the role for each of these cerebrovascular indices in monitoring of TBI patients.