Mortality and long-term functional outcome associated with intracranial pressure after traumatic brain injury
Mortality and long-term functional outcome associated with intracranial pressure after traumatic brain injury
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DOI：
10.1007/s00134-012-2655-4
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发表时间：
2012-11-01
影响因子：
38.9
通讯作者：
Treggiari, Miriam M.
中科院分区：
文献类型：
--
作者：
Badri, Shide;Chen, Jasper;Treggiari, Miriam M.
颅内压（ICP）升高与严重创伤性脑损伤（TBI）患者的死亡率增加相关。我们研究了颅内压升高是否与成人TBI患者的死亡率、功能状态和神经心理功能独立相关，并对499名参与者的随机试验数据进行了二次分析。主要终点为6个月内的死亡率和功能状态和神经心理功能（记忆力、信息处理速度、执行功能）的复合指标。在监测的第一个48小时内，ICP曲线（平均ICP）下的面积是主要的预测因素。多变量回归分析用于调整先验定义的混杂因素：年龄、格拉斯哥昏迷评分、简明损伤量表头和缺氧。总6个月死亡率为18%。与平均ICP升高10-mmHg相比，死亡率的校正比值比为3.12（95%置信区间1.79，5.44; p < 0.01）。总体而言，较高的平均ICP与功能状态和神经心理功能下降相关（p < 0.01）。重要的是，在幸存者中，平均ICP增加与神经心理学测试表现较差无关（p = 0.46）。在中度或重度TBI患者中，监测前48小时的平均ICP是死亡率和6个月随访时功能和神经心理学结局复合终点的独立预测因子。然而，在幸存者中，平均ICP和神经心理功能之间没有关联。
Elevated intracranial pressure (ICP) has been associated with increased mortality in patients with severe traumatic brain injury (TBI). We have examined whether raised ICP is independently associated with mortality, functional status and neuropsychological functioning in adult TBI patients.Data from a randomized trial of 499 participants were secondarily analyzed. The primary endpoints were mortality and a composite measure of functional status and neuropsychological function (memory, speed of information processing, executive function) over a 6-month period. The area under the curve of the ICP profile (average ICP) during the first 48 h of monitoring was the main predictor of interest. Multivariable regression was used to adjust for a priori defined confounders: age, Glasgow Coma Score, Abbreviated Injury Scale-head and hypoxia.Of the participants, 365 patients had complete 48-h ICP data. The overall 6-month mortality was 18 %. The adjusted odds ratio of mortality comparing 10-mmHg increases in average ICP was 3.12 (95 % confidence interval 1.79, 5.44; p < 0.01). Overall, higher average ICP was associated with decreased functional status and neuropsychological functioning (p < 0.01). Importantly, among survivors, increasing average ICP was not independently associated with worse performance on neuropsychological testing (p = 0.46).Average ICP in the first 48 h of monitoring was an independent predictor of mortality and of a composite endpoint of functional and neuropsychological outcome at the 6-month follow-up in moderate or severe TBI patients. However, there was no association between average ICP and neuropsychological functioning among survivors.