Univariate comparison of performance of different cerebrovascular reactivity indices for outcome association in adult TBI : a CENTER-TBI study
BACKGROUND: Monitoring cerebrovascular reactivity in adult traumatic brain injury (TBI) has been linked to global patient outcome. Three intra-cranial pressure (ICP)-derived indices have been described. It is unknown which index is superior for outcome association in TBI outside previous single-center evaluations. The goal of this study is to evaluate indices for 6- to 12-month outcome association using uniform data harvested in multiple centers.
METHODS: Using the prospectively collected data from the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study, the following indices of cerebrovascular reactivity were derived: PRx (correlation between ICP and mean arterial pressure (MAP)), PAx (correlation between pulse amplitude of ICP (AMP) and MAP), and RAC (correlation between AMP and cerebral perfusion pressure (CPP)). Univariate logistic regression models were created to assess the association between vascular reactivity indices with global dichotomized outcome at 6 to 12 months, as assessed by Glasgow Outcome Score-Extended (GOSE). Models were compared via area under the receiver operating curve (AUC) and Delong's test.
RESULTS: Two separate patient groups from this cohort were assessed: the total population with available data (n = 204) and only those without decompressive craniectomy (n = 159), with identical results. PRx, PAx, and RAC perform similar in outcome association for both dichotomized outcomes, alive/dead and favorable/unfavorable, with RAC trending towards higher AUC values. There were statistically higher mean values for the index, % time above threshold, and hourly dose above threshold for each of PRx, PAx, and RAC in those patients with poor outcomes.
CONCLUSIONS: PRx, PAx, and RAC appear similar in their associations with 6- to 12-month outcome in moderate/severe adult TBI, with RAC showing tendency to achieve stronger associations. Further work is required to determine the role for each of these cerebrovascular indices in monitoring of TBI patients.
| Errataetall: |
CommentIn: Acta Neurochir (Wien). 2019 Jun;161(6):1215-1216. - PMID 30820664 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:161 |
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| Enthalten in: |
Acta neurochirurgica - 161(2019), 6 vom: 15. Juni, Seite 1217-1227 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Zeiler, Frederick A [VerfasserIn] |
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| Links: |
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| Themen: |
Autoregulation |
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| Anmerkungen: |
Date Completed 13.04.2020 Date Revised 13.04.2020 published: Print-Electronic CommentIn: Acta Neurochir (Wien). 2019 Jun;161(6):1215-1216. - PMID 30820664 Citation Status MEDLINE |
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| doi: |
10.1007/s00701-019-03844-1 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM295005114 |
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| 041 | |a eng | ||
| 100 | 1 | |a Zeiler, Frederick A |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Univariate comparison of performance of different cerebrovascular reactivity indices for outcome association in adult TBI |b a CENTER-TBI study |
| 264 | 1 | |c 2019 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 13.04.2020 | ||
| 500 | |a Date Revised 13.04.2020 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Acta Neurochir (Wien). 2019 Jun;161(6):1215-1216. - PMID 30820664 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Monitoring cerebrovascular reactivity in adult traumatic brain injury (TBI) has been linked to global patient outcome. Three intra-cranial pressure (ICP)-derived indices have been described. It is unknown which index is superior for outcome association in TBI outside previous single-center evaluations. The goal of this study is to evaluate indices for 6- to 12-month outcome association using uniform data harvested in multiple centers | ||
| 520 | |a METHODS: Using the prospectively collected data from the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study, the following indices of cerebrovascular reactivity were derived: PRx (correlation between ICP and mean arterial pressure (MAP)), PAx (correlation between pulse amplitude of ICP (AMP) and MAP), and RAC (correlation between AMP and cerebral perfusion pressure (CPP)). Univariate logistic regression models were created to assess the association between vascular reactivity indices with global dichotomized outcome at 6 to 12 months, as assessed by Glasgow Outcome Score-Extended (GOSE). Models were compared via area under the receiver operating curve (AUC) and Delong's test | ||
| 520 | |a RESULTS: Two separate patient groups from this cohort were assessed: the total population with available data (n = 204) and only those without decompressive craniectomy (n = 159), with identical results. PRx, PAx, and RAC perform similar in outcome association for both dichotomized outcomes, alive/dead and favorable/unfavorable, with RAC trending towards higher AUC values. There were statistically higher mean values for the index, % time above threshold, and hourly dose above threshold for each of PRx, PAx, and RAC in those patients with poor outcomes | ||
| 520 | |a CONCLUSIONS: PRx, PAx, and RAC appear similar in their associations with 6- to 12-month outcome in moderate/severe adult TBI, with RAC showing tendency to achieve stronger associations. Further work is required to determine the role for each of these cerebrovascular indices in monitoring of TBI patients | ||
| 650 | 4 | |a Comparative Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Autoregulation | |
| 650 | 4 | |a Cerebrovascular reactivity | |
| 650 | 4 | |a ICP indices | |
| 650 | 4 | |a Outcome analysis | |
| 700 | 1 | |a Ercole, Ari |e verfasserin |4 aut | |
| 700 | 1 | |a Cabeleira, Manuel |e verfasserin |4 aut | |
| 700 | 1 | |a Zoerle, Tommaso |e verfasserin |4 aut | |
| 700 | 1 | |a Stocchetti, Nino |e verfasserin |4 aut | |
| 700 | 1 | |a Menon, David K |e verfasserin |4 aut | |
| 700 | 1 | |a Smielewski, Peter |e verfasserin |4 aut | |
| 700 | 1 | |a Czosnyka, Marek |e verfasserin |4 aut | |
| 700 | 0 | |a CENTER-TBI High Resolution Sub-Study Participants and Investigators |e verfasserin |4 aut | |
| 700 | 1 | |a Anke, Audny |e investigator |4 oth | |
| 700 | 1 | |a Beer, Ronny |e investigator |4 oth | |
| 700 | 1 | |a Bellander, Bo-Michael |e investigator |4 oth | |
| 700 | 1 | |a Buki, Andras |e investigator |4 oth | |
| 700 | 1 | |a Chevallard, Giorgio |e investigator |4 oth | |
| 700 | 1 | |a Chieregato, Arturo |e investigator |4 oth | |
| 700 | 1 | |a Citerio, Giuseppe |e investigator |4 oth | |
| 700 | 1 | |a Czeiter, Endre |e investigator |4 oth | |
| 700 | 1 | |a Depreitere, Bart |e investigator |4 oth | |
| 700 | 1 | |a Eapen, George |e investigator |4 oth | |
| 700 | 1 | |a Frisvold, Shirin |e investigator |4 oth | |
| 700 | 1 | |a Helbok, Raimund |e investigator |4 oth | |
| 700 | 1 | |a Jankowski, Stefan |e investigator |4 oth | |
| 700 | 1 | |a Kondziella, Daniel |e investigator |4 oth | |
| 700 | 1 | |a Koskinen, Lars-Owe |e investigator |4 oth | |
| 700 | 1 | |a Meyfroidt, Geert |e investigator |4 oth | |
| 700 | 1 | |a Moeller, Kirsten |e investigator |4 oth | |
| 700 | 1 | |a Nelson, David |e investigator |4 oth | |
| 700 | 1 | |a Piippo-Karjalainen, Anna |e investigator |4 oth | |
| 700 | 1 | |a Radoi, Andreea |e investigator |4 oth | |
| 700 | 1 | |a Ragauskas, Arminas |e investigator |4 oth | |
| 700 | 1 | |a Raj, Rahul |e investigator |4 oth | |
| 700 | 1 | |a Rhodes, Jonathan |e investigator |4 oth | |
| 700 | 1 | |a Rocka, Saulius |e investigator |4 oth | |
| 700 | 1 | |a Rossaint, Rolf |e investigator |4 oth | |
| 700 | 1 | |a Sahuquillo, Juan |e investigator |4 oth | |
| 700 | 1 | |a Sakowitz, Oliver |e investigator |4 oth | |
| 700 | 1 | |a Stevanovic, Ana |e investigator |4 oth | |
| 700 | 1 | |a Sundström, Nina |e investigator |4 oth | |
| 700 | 1 | |a Takala, Riikka |e investigator |4 oth | |
| 700 | 1 | |a Tamosuitis, Tomas |e investigator |4 oth | |
| 700 | 1 | |a Tenovuo, Olli |e investigator |4 oth | |
| 700 | 1 | |a Vajkoczy, Peter |e investigator |4 oth | |
| 700 | 1 | |a Vargiolu, Alessia |e investigator |4 oth | |
| 700 | 1 | |a Vilcinis, Rimantas |e investigator |4 oth | |
| 700 | 1 | |a Wolf, Stefa |e investigator |4 oth | |
| 700 | 1 | |a Younsi, Alexander |e investigator |4 oth | |
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