Author:
Beqiri Erta,Zeiler Frederick A.,Ercole Ari,Placek Michal M.,Tas Jeanette,Donnelly Joseph,Aries Marcel J. H.,Hutchinson Peter J.,Menon David,Stocchetti Nino,Czosnyka Marek,Smielewski Peter,Anke Audny,Beer Ronny,Bellander Bo-Michael,Beqiri Erta,Buki Andras,Cabeleira Manuel,Carbonara Marco,Chieregato Arturo,Citerio Giuseppe,Clusmann Hans,Czeiter Endre,Czosnyka Marek,Depreitere Bart,Ercole Ari,Frisvold Shirin,Helbok Raimund,Jankowski Stefan,Kondziella Daniel,Koskinen Lars-Owe,Kowark Ana,Menon David K.,Meyfroidt Geert,Moeller Kirsten,Nelson David,Piippo-Karjalainen Anna,Radoi Andreea,Ragauskas Arminas,Raj Rahul,Rhodes Jonathan,Rocka Saulius,Rossaint Rolf,Sahuquillo Juan,Sakowitz Oliver,Smielewski Peter,Stocchetti Nino,Sundström Nina,Takala Riikka,Tamosuitis Tomas,Tenovuo Olli,Unterberg Andreas,Vajkoczy Peter,Vargiolu Alessia,Vilcinis Rimantas,Wolf Stefan,Younsi Alexander,Zeiler Frederick A.,
Abstract
Abstract
Background
A previous retrospective single-centre study suggested that the percentage of time spent with cerebral perfusion pressure (CPP) below the individual lower limit of reactivity (LLR) is associated with mortality in traumatic brain injury (TBI) patients. We aim to validate this in a large multicentre cohort.
Methods
Recordings from 171 TBI patients from the high-resolution cohort of the CENTER-TBI study were processed with ICM+ software. We derived LLR as a time trend of CPP at a level for which the pressure reactivity index (PRx) indicates impaired cerebrovascular reactivity with low CPP. The relationship with mortality was assessed with Mann-U test (first 7-day period), Kruskal–Wallis (daily analysis for 7 days), univariate and multivariate logistic regression models. AUCs (CI 95%) were calculated and compared using DeLong’s test.
Results
Average LLR over the first 7 days was above 60 mmHg in 48% of patients. %time with CPP < LLR could predict mortality (AUC 0.73, p = < 0.001). This association becomes significant starting from the third day post injury. The relationship was maintained when correcting for IMPACT covariates or for high ICP.
Conclusions
Using a multicentre cohort, we confirmed that CPP below LLR was associated with mortality during the first seven days post injury.
Funder
CTBI scholarship
Medical Research Council
Gates Cambridge Scholarship
NSERC
Canadian Institutes of Health Research
MPI Neuroscience Research Operating Fund
Health Sciences Centre Foundation Winnipeg
Canada Foundation for Innovation
Research Manitoba
University of Manitoba MPI Professorship in Neuroscience
European Union 7th Framework program
HersenStrijd fonds
Neurological Foundation of New Zealand
NIHR Cambridge Biomedical Research Centre
ZNS - Hannelore Kohl Stiftung
OneMind
Integra LifeSciences
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine