Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Phipps Suite 455, Baltimore, MD, 21287, USA.
Neurocrit Care. 2022 Aug;37(Suppl 2):259-266. doi: 10.1007/s12028-022-01475-6. Epub 2022 Mar 21.
Heterogeneity is recognized as a major barrier in efforts to improve the care and outcomes of patients with traumatic brain injury (TBI). Even within the narrower stratum of moderate and severe TBI, current management approaches do not capture the complexity of this condition characterized by manifold clinical, anatomical, and pathophysiologic features. One approach to heterogeneity may be to resolve undifferentiated TBI populations into endotypes, subclasses that are distinguished by shared biological characteristics. The endotype paradigm has been explored in a range of medical domains, including psychiatry, oncology, immunology, and pulmonology. In intensive care, endotypes are being investigated for syndromes such as sepsis and acute respiratory distress syndrome. This review provides an overview of the endotype paradigm as well as some of its methods and use cases. A conceptual framework is proposed for endotype research in moderate and severe TBI, together with a scientific road map for endotype discovery and validation in this population.
异质性是改善创伤性脑损伤（TBI）患者治疗效果的主要障碍。即使在中等和重度 TBI 的更窄范围内，目前的管理方法也无法捕捉到这种疾病的复杂性，其具有多种临床、解剖和病理生理特征。解决异质性的一种方法可能是将未分化的 TBI 人群分为具有共同生物学特征的亚类，即内型。内型范式已在包括精神病学、肿瘤学、免疫学和肺病学在内的一系列医学领域中进行了探索。在重症监护中，正在为败血症和急性呼吸窘迫综合征等综合征研究内型。本文综述了内型范式及其一些方法和应用案例。提出了一个中度和重度 TBI 中内型研究的概念框架，以及在该人群中发现和验证内型的科学路线图。
