Compensatory-reserve-weighted intracranial pressure versus intracranial pressure for outcome association in adult traumatic brain injury: a CENTER-TBI validation study
Background: Compensatory-reserve-weighted intracranial pressure (wICP) has recently been suggested as a supplementary measure of intracranial pressure (ICP) in adult traumatic brain injury (TBI), with a single-center study suggesting an association with mortality at 6 months. No multi-center studies...
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| Main Authors: | , , |
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| Corporate Author: | |
| Format: | Article (Journal) |
| Language: | English |
| Published: |
3 May 2019
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| In: |
Acta neurochirurgica
Year: 2019, Volume: 161, Issue: 7, Pages: 1275-1284 |
| ISSN: | 0942-0940 |
| DOI: | 10.1007/s00701-019-03915-3 |
| Online Access: | Verlag, Volltext: https://doi.org/10.1007/s00701-019-03915-3
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| Author Notes: | Frederick A. Zeiler, Ari Ercole, Manuel Cabeleira, Erta Beqiri, Tommaso Zoerle, Marco Carbonara, Nino Stocchetti, David K. Menon, Peter Smielewski, Marek Czosnyka ; CENTER-TBI High Resolution ICU Sub-Study Participants and Investigators: 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, Stefan Wolf, Alexander Younsi |
| Summary: | Background: Compensatory-reserve-weighted intracranial pressure (wICP) has recently been suggested as a supplementary measure of intracranial pressure (ICP) in adult traumatic brain injury (TBI), with a single-center study suggesting an association with mortality at 6 months. No multi-center studies exist to validate this relationship. The goal was to compare wICP to ICP for association with outcome in a multi-center TBI cohort. Methods: Using the Collaborative European Neuro Trauma Effectiveness Research in TBI (CENTER-TBI) high-resolution intensive care unit (ICU) cohort, we derived ICP and wICP (calculated as wICP = (1 − RAP) × ICP; where RAP is the compensatory reserve index derived from the moving correlation between pulse amplitude of ICP and ICP). Various univariate logistic regression models were created comparing ICP and wICP to dichotomized outcome at 6 to 12 months, based on Glasgow Outcome Score—Extended (GOSE) (alive/dead—GOSE ≥ 2/GOSE = 1; favorable/unfavorable—GOSE 5 to 8/GOSE 1 to 4, respectively). Models were compared using area under the receiver operating curves (AUC) and p values.ResultswICP displayed higher AUC compared to ICP on univariate regression for alive/dead outcome compared to mean ICP (AUC 0.712, 95% CI 0.615-0.810, p = 0.0002, and AUC 0.642, 95% CI 0.538-746, p < 0.0001, respectively; no significant difference on Delong’s test), and for favorable/unfavorable outcome (AUC 0.627, 95% CI 0.548-0.705, p = 0.015, and AUC 0.495, 95% CI 0.413-0.577, p = 0.059; significantly different using Delong’s test p = 0.002), with lower wICP values associated with improved outcomes (p < 0.05 for both). These relationships on univariate analysis held true even when comparing the wICP models with those containing both ICP and RAP integrated area under the curve over time (p < 0.05 for all via Delong’s test).Conclusions: Compensatory-reserve-weighted ICP displays superior outcome association for both alive/dead and favorable/unfavorable dichotomized outcomes in adult TBI, through univariate analysis. Lower wICP is associated with better global outcomes. The results of this study provide multi-center validation of those seen in a previous single-center study. |
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| Item Description: | Gesehen am 29.10.2019 |
| Physical Description: | Online Resource |
| ISSN: | 0942-0940 |
| DOI: | 10.1007/s00701-019-03915-3 |