Compensatory-reserve-weighted intracranial pressure versus intracranial pressure for outcome association in adult traumatic brain injury: a CENTER-TBI validation study.
CENTER-TBI High Resolution ICU Sub-Study Participants and Investigators,
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Zeiler, F., Ercole, A., Cabeleira, M., Beqiri, E., Zoerle, T., Carbonara, M., Stocchetti, N., et al. (2019). Compensatory-reserve-weighted intracranial pressure versus intracranial pressure for outcome association in adult traumatic brain injury: a CENTER-TBI validation study.. Acta neurochirurgica, 161 (7), 1275-1284. https://doi.org/10.1007/s00701-019-03915-3
Background: Compensatory 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 6-months. 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. Methods: Using 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)*ICP; 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 12-months, based on Glasgow Outcome Score – Extended (GOSE) (alive/dead - GOSE >=2/GOSE=1; favourable/unfavourable – GOSE 5 to 8/GOSE 1 to 4, respectively). Models were compared using area under the receiver operating curves (AUC) and p-values. Results: wICP 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<0.0001, respectively; no significant difference on Delong’s Test), and for favourable/unfavourable outcome (AUC 0.627, 95% CI 0.548-0.705, p=0.015 and AUC 0.495, 95% CI 0.413-0.577, p=0.059; significantly different using Delong’s Test p=0.002), with lower wICP values associated with improved outcomes (p<0.05 for both). These relationships on univariate analysis held true even when comparing the wICP models with those containing both ICP and RAP integrated area under the curve over time (p<0.05 for all via Delong’s Test). Conclusions: Compensatory reserve weighted ICP displays superior outcome association for both alive/dead and favourable/unfavourable dichotomized outcomes in adult TBI, through univariate analysis. Lower wICP is associated with better global outcomes. The results of this study provide multi-center validation of those seen in a previous single center study.
CENTER-TBI High Resolution ICU Sub-Study Participants and Investigators, Humans, Retrospective Studies, Intracranial Pressure, Adult, Aged, Middle Aged, Intensive Care Units, Female, Male, Brain Injuries, Traumatic
Data used in preparation of this manuscript were obtained in the context of CENTER-TBI, a large collaborative project with the support of the European Union 7th Framework program (EC grant 602150). Additional funding was obtained from the Hannelore Kohl Stiftung (Germany), from OneMind (USA) and from Integra LifeSciences Corporation (USA). DKM was also supported by funding from the National Institute for Health Research (NIHR, UK) through a Senior Investigator award and the Cambridge Biomedical Research Centre at the Cambridge University Hospitals NHS Foundation Trust. The study also received additional support from the NIHR Clinical Research network ... FAZ has received salary support for dedicated research time ... from: the Cambridge Commonwealth Trust Scholarship, the University of Manitoba Clinician Investigator Program, and the Royal College of Surgeons of Canada – Harry S. Morton Travelling Fellowship in Surgery. FAZ receives research support from the University of Manitoba Thorlakson Chair in Surgical Research Establishment Fund, the University of Manitoba Research Investment Fund (RIF), and the University of Manitoba Rudy Falk Clinician-Scientist Professorship Award. PS and MC receive part of licensing fees for the software ICM+ (Cambridge Enterprise Ltd, UK) used for data collection and analysis in this study.
EC FP7 CP (602150)
External DOI: https://doi.org/10.1007/s00701-019-03915-3
This record's URL: https://www.repository.cam.ac.uk/handle/1810/291759
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