Intracranial Pressure Trajectories: A Novel Approach to Informing Severe Traumatic Brain Injury Phenotypes.
Intracranial Pressure Trajectories: A Novel Approach to Informing Severe Traumatic Brain Injury Phenotypes.
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DOI：
10.1097/ccm.0000000000003361
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发表时间：
2018-11
影响因子：
8.8
通讯作者：
Kochanek PM
中科院分区：
文献类型：
--
作者：
Jha RM;Elmer J;Zusman BE;Desai S;Puccio AM;Okonkwo DO;Park SY;Shutter LA;Wallisch JS;Conley YP;Kochanek PM
创伤性脑损伤（TBI）的颅内压（ICP）是动态的，受损伤模式、治疗和遗传等因素的影响。现有的研究使用时不变的摘要ICP措施，从而可能失去时间趋势的关键信息。我们确定了严重TBI的纵向ICP轨迹，并评估它们是否预测结果。我们进一步询问模型，以探索ABCC 8多态性（一种已知的脑水肿调节因子）是否在癫痫组之间存在差异。前瞻性观察队列单中心学术医学中心404例严重TBI患者。我们使用基于组的轨迹模型来确定TBI后0-5天的每小时ICP轨迹，并结合风险因素调整（年龄、性别、GCS评分、颅骨切除术、原发性出血模式）。我们比较了6个月的结局（格拉斯哥结局量表（GOS）、残疾评定量表（DRS）、死亡率）和与脑水肿相关的ABCC 8标签单核苷酸多态性（rs 2237982、rs7105832）。回归模型确定是否自愿组预测的结果。六个连续性组模型最佳地拟合数据，识别在初始ICP、演变和>20 mmHg的尖峰的数量/比例方面不同的队列。在年龄、出血类型和颅骨切除率方面存在模式差异。ABCC 8多态性在各组之间存在差异。GOS（p=0.006）、DRS（p=0.001）、死亡率（p<0.0001）和rs 2237982（p=0.035）在各组之间存在差异。低ICP轨迹和持续性颅内高压都意外地预测了不良结局。ICP变异性在各组之间存在差异（p<0.001），可能反映了颅内弹性/顺应性的保留/受损。我们采用了一种新的方法研究TBI中的纵向/动态ICP模式。在风险调整模型中，确定了六组并预测了结果。如果得到验证，轨迹建模可能是与其他表型分析工具（如生物标志物和神经成像）结合开发ICP表型分析新方法的第一步。这可能是特别相关的变化TBI人口向老年人。
Intracranial pressure (ICP) in traumatic brain injury (TBI) is dynamic and influenced by factors like injury patterns, treatments and genetics. Existing studies use time-invariant summary ICP-measures thus potentially losing critical information about temporal trends. We identified longitudinal ICP-trajectories in severe-TBI and evaluated whether they predicted outcome. We further interrogated the model to explore whether ABCC8-polymorphisms (a known cerebral-edema regulator), differed across trajectory-groups. prospective observational cohort single-center academic medical center 404 severe-TBI patients. none We used group-based trajectory modeling to identify hourly ICP trajectories in days 0–5 post-TBI incorporating risk-factor adjustment (age, sex, GCS-score, craniectomy, primary hemorrhage pattern). We compared six-month outcomes (Glasgow Outcome Scale(GOS), Disability Rating Scale(DRS), mortality) and ABCC8 tag-single-nucleotide polymorphisms associated with cerebral edema (rs2237982, rs7105832) across groups. Regression models determined whether trajectory-groups predicted outcome. A six trajectory-group model best fit the data, identifying cohorts differing in initial ICP, evolution, and number/proportion of spikes >20 mmHg. There were pattern differences in age, hemorrhage type, and craniectomy rates. ABCC8 polymorphisms differed across groups. GOS (p=0.006), DRS (p=0.001), mortality (p<0.0001) and rs2237982 (p=0.035) differed across groups. Unfavorable outcomes were surprisingly predicted by both low ICP-trajectories and sustained intracranial hypertension. ICP-variability differed across groups (p<0.001) and may reflect preserved/impaired intracranial elastance/compliance. We employed a novel approach investigating longitudinal/dynamic ICP patterns in TBI. In a risk adjusted model, six groups were identified and predicted outcomes. If validated, trajectory modeling may be a first step towards developing a new, granular approach for ICP phenotyping in conjunction with other phenotyping tools like biomarkers and neuroimaging. This may be particularly relevant in light of changing TBI demographics towards the elderly.