TY - JOUR
T1 - Compensatory-reserve-weighted intracranial pressure versus intracranial pressure for outcome association in adult traumatic brain injury
T2 - a CENTER-TBI validation study
AU - CENTER-TBI High Resolution ICU Sub-Study Participants and Investigators
AU - Zeiler, Frederick A.
AU - Ercole, Ari
AU - Cabeleira, Manuel
AU - Beqiri, Erta
AU - Zoerle, Tommaso
AU - Carbonara, Marco
AU - Stocchetti, Nino
AU - Menon, David K.
AU - Smielewski, Peter
AU - Czosnyka, Marek
AU - Anke, Audny
AU - Beer, Ronny
AU - Bellander, Bo Michael
AU - Buki, Andras
AU - Chevallard, Giorgio
AU - Chieregato, Arturo
AU - Citerio, Giuseppe
AU - Czeiter, Endre
AU - Depreitere, Bart
AU - Eapen, George
AU - Frisvold, Shirin
AU - Helbok, Raimund
AU - Jankowski, Stefan
AU - Kondziella, Daniel
AU - Koskinen, Lars Owe
AU - Meyfroidt, Geert
AU - Moeller, Kirsten
AU - Nelson, David
AU - Piippo-Karjalainen, Anna
AU - Radoi, Andreea
AU - Ragauskas, Arminas
AU - Raj, Rahul
AU - Rhodes, Jonathan
AU - Rocka, Saulius
AU - Rossaint, Rolf
AU - Sahuquillo, Juan
AU - Sakowitz, Oliver
AU - Stevanovic, Ana
AU - Sundström, Nina
AU - Takala, Riikka
AU - Tamosuitis, Tomas
AU - Tenovuo, Olli
AU - Vajkoczy, Peter
AU - Vargiolu, Alessia
AU - Vilcinis, Rimantas
AU - Wolf, Stefan
AU - Younsi, Alexander
PY - 2019/1/1
Y1 - 2019/1/1
N2 - 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; favorable/unfavorable—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 favorable/unfavorable 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 favorable/unfavorable 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.
AB - 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; favorable/unfavorable—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 favorable/unfavorable 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 favorable/unfavorable 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.
KW - Compensatory reserve
KW - Intracranial pressure
KW - Outcome
KW - Weighted ICP
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U2 - 10.1007/s00701-019-03915-3
DO - 10.1007/s00701-019-03915-3
M3 - Article
AN - SCOPUS:85065409504
VL - 161
SP - 1275
EP - 1284
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
SN - 0001-6268
IS - 7
ER -