TY - JOUR
T1 - Impact of a posttraumatic cerebral infarction on outcome in patients with TBI
T2 - the Italian multicenter cohort INCEPT study
AU - Latronico, Nicola
AU - Piva, Simone
AU - Fagoni, Nazzareno
AU - Pinelli, Lorenzo
AU - Frigerio, Michele
AU - Tintori, Davide
AU - Berardino, Maurizio
AU - Bottazzi, Andrea
AU - Carnevale, Livio
AU - Casalicchio, Tiziana
AU - Castioni, Carlo Alberto
AU - Cavallo, Simona
AU - Cerasti, Davide
AU - Citerio, Giuseppe
AU - Fontanella, Marco
AU - Galiberti, Serena
AU - Girardini, Alan
AU - Gritti, Paolo
AU - Manara, Ornella
AU - Maremmani, Paolo
AU - Mazzani, Roberta
AU - Natalini, Giuseppe
AU - Patassini, Mirko
AU - Perna, Maria Elena
AU - Pesaresi, Ilaria
AU - Radolovich, Danila Katia
AU - Saini, Maurizio
AU - Stefini, Roberto
AU - Minelli, Cosetta
AU - Gasparotti, Roberto
AU - Rasulo, Francesco A.
PY - 2020/2/3
Y1 - 2020/2/3
N2 - BACKGROUND: Post-traumatic cerebral infarction (PTCI) is common after traumatic brain injury (TBI). It is unclear what the occurrence of a PTCI is, how it impacts the long-term outcome, and whether it adds incremental prognostic value to established outcome predictors. METHODS: This was a prospective multicenter cohort study of moderate and severe TBI patients. The primary objective was to evaluate if PTCI was an independent risk factor for the 6-month outcome assessed with the Glasgow Outcome Scale (GOS). We also assessed the PTCI occurrence and if it adds incremental value to the International Mission for Prognosis and Clinical Trial design in TBI (IMPACT) core and extended models. RESULTS: We enrolled 143 patients, of whom 47 (32.9%) developed a PTCI. In the multiple ordered logistic regression, PTCI was retained in both the core and extended IMPACT models as an independent predictor of the GOS. The predictive performances increased significantly when PTCI was added to the IMPACT core model (AUC = 0.73, 95% C.I. 0.66-0.82; increased to AUC = 0.79, 95% CI 0.71-0.83, p = 0.0007) and extended model (AUC = 0.74, 95% C.I. 0.65-0.81 increased to AUC = 0.80, 95% C.I. 0.69-0.85; p = 0.00008). Patients with PTCI showed higher ICU mortality and 6-month mortality, whereas hospital mortality did not differ between the two groups. CONCLUSIONS: PTCI is a common complication in patients suffering from a moderate or severe TBI and is an independent risk factor for long-term disability. The addition of PTCI to the IMPACT core and extended predictive models significantly increased their performance in predicting the GOS. TRIAL REGISTRATION: The present study was registered in ClinicalTrial.gov with the ID number NCT02430324.
AB - BACKGROUND: Post-traumatic cerebral infarction (PTCI) is common after traumatic brain injury (TBI). It is unclear what the occurrence of a PTCI is, how it impacts the long-term outcome, and whether it adds incremental prognostic value to established outcome predictors. METHODS: This was a prospective multicenter cohort study of moderate and severe TBI patients. The primary objective was to evaluate if PTCI was an independent risk factor for the 6-month outcome assessed with the Glasgow Outcome Scale (GOS). We also assessed the PTCI occurrence and if it adds incremental value to the International Mission for Prognosis and Clinical Trial design in TBI (IMPACT) core and extended models. RESULTS: We enrolled 143 patients, of whom 47 (32.9%) developed a PTCI. In the multiple ordered logistic regression, PTCI was retained in both the core and extended IMPACT models as an independent predictor of the GOS. The predictive performances increased significantly when PTCI was added to the IMPACT core model (AUC = 0.73, 95% C.I. 0.66-0.82; increased to AUC = 0.79, 95% CI 0.71-0.83, p = 0.0007) and extended model (AUC = 0.74, 95% C.I. 0.65-0.81 increased to AUC = 0.80, 95% C.I. 0.69-0.85; p = 0.00008). Patients with PTCI showed higher ICU mortality and 6-month mortality, whereas hospital mortality did not differ between the two groups. CONCLUSIONS: PTCI is a common complication in patients suffering from a moderate or severe TBI and is an independent risk factor for long-term disability. The addition of PTCI to the IMPACT core and extended predictive models significantly increased their performance in predicting the GOS. TRIAL REGISTRATION: The present study was registered in ClinicalTrial.gov with the ID number NCT02430324.
KW - Disability
KW - Long term outcome
KW - Posttraumatic cerebral infarction
KW - Traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=85078892879&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85078892879&partnerID=8YFLogxK
U2 - 10.1186/s13054-020-2746-5
DO - 10.1186/s13054-020-2746-5
M3 - Article
C2 - 32014041
VL - 24
JO - Critical Care
JF - Critical Care
SN - 1466-609X
IS - 1
ER -