Critical Thresholds for Cerebrovascular Reactivity After Traumatic Brain Injury
Critical Thresholds for Cerebrovascular Reactivity After Traumatic Brain Injury
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DOI：
10.1007/s12028-011-9630-8
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发表时间：
2012-04-01
影响因子：
3.5
通讯作者：
Czosnyka, M.
中科院分区：
文献类型：
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作者：
Sorrentino, E.;Diedler, J.;Czosnyka, M.
压力反应指数（PRx）是一种有用的颅脑损伤监测工具，但其临界值仍是一个问题。使用我们的TBI数据库，我们确定了PRx的阈值和其他监测参数，这些参数可以最大限度地提高死亡/生存和有利/不利结果之间的统计差异。我们还研究了这些阈值如何依赖于临床因素，如年龄、性别和初始GCS。方法从数据库中选取459例符合条件的患者。根据生存/死亡或有利/不利结局以及PRx、ICP和CPP的不同阈值，创建2 9 2格式的表对患者进行分组。计算皮尔逊卡方，并假设返回最高分的阈值具有最佳判别值。根据临床因素进行分割后重复上述步骤。结果在所有患者中，我们发现PRx有不同的生存阈值（0.25）和良好结局阈值（0.05）。CPP的阈值为70 mmHg， ICP的阈值为22 mmHg，确定了生存和有利结果。女性和55岁以上患者的ICP阈值较低（18 mmHg）。在logistic回归模型中，与死亡率和不良结局相关的自变量为年龄、GCS、ICP和PRx。结论PRx的预后作用得到证实，但其预后良好的阈值0.05低于生存的阈值0.25。ICP结果符合现行指南。然而，老年人和女性中较低的数值表明，这些人群对颅内高压的易感性增加。
Introduction Pressure-reactivity index (PRx) is a useful tool in brain monitoring of trauma patients, but the question remains about its critical values. Using our TBI database, we identified the thresholds for PRx and other monitored parameters that maximize the statistical difference between death/survival and favorable/unfavorable outcomes. We also investigated how these thresholds depend on clinical factors such as age, gender and initial GCS.Methods A total of 459 patients from our database were eligible. Tables of 2 9 2 format were created grouping patients according to survival/death or favorable/unfavorable outcomes and varying thresholds for PRx, ICP and CPP. Pearson's chi square was calculated, and the thresholds returning the highest score were assumed to have the best discriminative value. The same procedure was repeated after division according to clinical factors.Results In all patients, we found that PRx had different thresholds for survival (0.25) and for favorable outcome (0.05). Thresholds of 70 mmHg for CPP and 22 mmHg for ICP were identified for both survival and favorable outcomes. The ICP threshold for favorable outcome was lower (18 mmHg) in females and patients older than 55 years. In logistic regression models, independent variables associating with mortality and unfavorable outcome were age, GCS, ICP and PRx.Conclusion The prognostic role of PRx is confirmed but with a lower threshold of 0.05 for favorable outcome than for survival (0.25). Results for ICP are in line with current guidelines. However, the lower value in elderly and in females suggests increased vulnerability to intracranial hypertension in these groups.