成人创伤性脑损伤中不同脑血管反应性指数与结局相关性的单变量比较：CENTER-TBI 研究。
Univariate comparison of performance of different cerebrovascular reactivity indices for outcome association in adult TBI: a CENTER-TBI study.
机构信息
Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3A 1R9, Canada.
出版信息
Acta Neurochir (Wien). 2019 Jun;161(6):1217-1227. doi: 10.1007/s00701-019-03844-1. Epub 2019 Mar 15.
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.
背景
监测成人创伤性脑损伤（TBI）中的脑血管反应性与整体患者预后相关。已经描述了三种颅内压（ICP）衍生指数。尚不清楚在以前的单中心评估之外，哪种指数更适合 TBI 的预后相关性。本研究的目的是使用多中心采集的统一数据评估 6 至 12 个月的预后相关性指数。
方法
使用协作性欧洲神经创伤功效研究在 TBI（CENTER-TBI）研究中的前瞻性收集的数据，得出以下脑血管反应性指数：PRx（ICP 和平均动脉压（MAP）之间的相关性），PAx（ICP 的脉搏幅度（AMP）和 MAP 之间的相关性），和 RAC（AMP 和脑灌注压（CPP）之间的相关性）。使用格拉斯哥预后评分扩展（GOSE）评估 6 至 12 个月时的全球二分结果，创建单变量逻辑回归模型来评估血管反应性指数与血管反应性指数之间的相关性。通过接收者操作特征曲线（AUC）下面积和 Delong 检验比较模型。
结果
使用该队列中的两个独立患者组评估了该模型：具有可用数据的总人群（n=204）和仅没有去骨瓣减压术的人群（n=159），结果相同。PRx、PAx 和 RAC 在两种二分结果（存活/死亡和有利/不利）的预后相关性中表现相似，RAC 的 AUC 值呈上升趋势。在预后不良的患者中，PRx、PAx 和 RAC 的指数、超过阈值的百分比时间和每小时超过阈值的剂量均具有统计学上较高的平均值。
结论
PRx、PAx 和 RAC 在中度/重度成人 TBI 的 6 至 12 个月预后中表现相似，RAC 显示出更强的相关性趋势。需要进一步研究以确定这些脑血管指数在监测 TBI 患者中的作用。
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