颅脑创伤后脑梗死对 TBI 患者结局的影响：意大利多中心队列 INCEPT 研究。
Impact of a posttraumatic cerebral infarction on outcome in patients with TBI: the Italian multicenter cohort INCEPT study.
机构信息
Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
Department of Anesthesia, Intensive Care and Emergency, ASST Spedali Civili University Hospital, Piazzale Ospedali Civili 1, 25121, Brescia, Italy.
出版信息
Crit Care. 2020 Feb 3;24(1):33. doi: 10.1186/s13054-020-2746-5.
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.
背景
创伤性脑损伤（TBI）后常发生创伤后脑梗死（PTCI）。目前尚不清楚 PTCI 的发生情况如何，它对长期预后的影响，以及它是否为既定预后预测因子增加了增量预后价值。
方法
这是一项针对中重度 TBI 患者的前瞻性多中心队列研究。主要目的是评估 PTCI 是否是格拉斯哥预后量表（GOS）评估的 6 个月预后的独立危险因素。我们还评估了 PTCI 的发生情况，以及它是否为国际创伤预后和临床试验设计（IMPACT）核心和扩展模型增加了增量价值。
结果
我们共纳入 143 例患者，其中 47 例（32.9%）发生了 PTCI。在多序贯逻辑回归中，PTCI 在核心和扩展 IMPACT 模型中均被保留为 GOS 的独立预测因子。当将 PTCI 添加到 IMPACT 核心模型（AUC=0.73，95%CI 0.66-0.82；增加到 AUC=0.79，95%CI 0.71-0.83，p=0.0007）和扩展模型（AUC=0.74，95%CI 0.65-0.81 增加到 AUC=0.80，95%CI 0.69-0.85；p=0.00008）时，预测性能显著提高。发生 PTCI 的患者 ICU 死亡率和 6 个月死亡率较高，而两组间医院死亡率无差异。
结论
PTCI 是中重度 TBI 患者的常见并发症，是长期残疾的独立危险因素。将 PTCI 添加到 IMPACT 核心和扩展预测模型中显著提高了它们预测 GOS 的性能。
试验注册
本研究在 ClinicalTrial.gov 上注册，注册号为 NCT02430324。
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