Compensatory-reserve-weighted intracranial pressure versus intracranial pressure for outcome association in adult traumatic brain injury: a CENTER-TBI validation study
Compensatory-reserve-weighted intracranial pressure versus intracranial pressure for outcome association in adult traumatic brain injury: a CENTER-TBI validation study
复制标题
DOI：
10.1007/s00701-019-03915-3
复制
发表时间：
2019-07-01
影响因子：
2.4
通讯作者：
Younsi, Alexander
中科院分区：
文献类型：
--
作者：
Zeiler, Frederick A.;Ercole, Ari;Younsi, Alexander
背景补偿储备加权颅内压 (wICP) 最近被建议作为成人创伤性脑损伤 (TBI) 颅内压 (ICP) 的补充测量，一项单中心研究表明与 6 个月死亡率相关。尚无多中心研究来验证这种关系。目的是比较 wICP 与 ICP 与多中心 TBI 队列中结果的关联。方法使用 TBI (CENTER-TBI) 高分辨率重症监护病房 (ICU) 队列中的欧洲神经创伤有效性协作研究，我们得出 ICP 和 wICP（计算为 wICP=(1-RAP)xICP；其中 RAP 是从 ICP 和 ICP 脉冲幅度之间的移动相关性得出的代偿储备指数）。基于格拉斯哥结果评分扩展 (GOSE)（存活/死亡 GOSE 2/GOSE=1；有利/不利 GOSE 5 至 8/GOSE 1 至 4，分别），创建了各种单变量逻辑回归模型，将 ICP 和 wICP 与 6 至 12 个月的二分结果进行比较。使用受试者工作曲线下面积 (AUC) 和 p 值对模型进行比较。结果与平均 ICP 相比，在活/死亡结果的单变量回归中，swICP 显示出比 ICP 更高的 AUC（AUC 0.712，95% CI 0.615-0.810，p=0.0002，AUC 0.642，95% CI 0.538-746，p
BackgroundCompensatory-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 6months. 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.MethodsUsing 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)xICP; 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 12months, based on Glasgow Outcome ScoreExtended (GOSE) (alive/deadGOSE 2/GOSE=1; favorable/unfavorableGOSE 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