创伤性脑损伤后预先存在的血管危险因素与结局的相关性：TRACK-TBI 研究。
Associations of Preexisting Vascular Risk Factors With Outcomes After Traumatic Brain Injury: A TRACK-TBI Study.
机构信息
Department of Neurology, Perelman School of Medicine, University of Pennsylvania Philadelphia (Drs Schneider, Diaz-Arrastia, and Sandsmark); Departments of Neurological Surgery (Mr Barber and Dr Temkin) and Biostatistics (Dr Temkin), University of Washington, Seattle; and Departments of Neurology (Dr Gardner) and Neurosurgery (Dr Manley), University of California San Francisco, San Francisco.
出版信息
J Head Trauma Rehabil. 2023;38(2):E88-E98. doi: 10.1097/HTR.0000000000000798. Epub 2022 Jun 9.
OBJECTIVE
To evaluate associations of preinjury vascular risk factors with traumatic brain injury (TBI) outcomes.
SETTING
The level 1 trauma center-based T ransforming R esearch a nd C linical K nowledge in TBI (TRACK-TBI) Study.
PARTICIPANTS
A total of 2361 acute TBI patients 18 years or older who presented to the emergency department within 24 hours of head trauma warranting clinical evaluation with a noncontrast head CT between February 26, 2014, and August 8, 2018.
DESIGN
A multicenter prospective cohort study.
MAIN MEASURES
Vascular risk factors (hypertension, diabetes, hyperlipidemia, and smoking) were assessed at baseline by self- or proxy-report and chart review. The primary outcome was the 6-month Glasgow Outcome Scale-Extended TBI version (GOSE-TBI). Secondary 6-month outcomes included the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), the Satisfaction with Life Scale (SWLS), and the 18-item Brief Symptom Inventory Global Severity Index (BSI-18-GSI).
RESULTS
Mean age of participants was 42 years, 31% were women, and 16% were Black. Current smoking was the most common vascular risk factor (29%), followed by hypertension (17%), diabetes (8%), and hyperlipidemia (6%). Smoking was the only risk factor associated with worse scores on all 4 outcome indices. Hypertension and diabetes were associated with worse RPQ scores, and hypertension was associated with worse BSI-18-GSI scores (all P < .05). Compared with individuals with no vascular risk factors, individuals with 1 but not 2 or more vascular risk factors had significantly worse GOSE-TBI and SWLS scores, while a higher burden of vascular risk factors was significantly associated with worse RPQ and BSI-18-GSI scores.
CONCLUSION
Our study found that preinjury vascular risk factors, especially smoking, are associated with worse outcomes after TBI. Aggressive postinjury treatment of vascular risk factors may be a promising strategy to improve TBI outcomes.
目的
评估损伤前血管危险因素与创伤性脑损伤（TBI）结局的关系。
背景
基于 1 级创伤中心的转化研究和 TBI 临床知识（TRACK-TBI）研究。
参与者
2014 年 2 月 26 日至 2018 年 8 月 8 日，共有 2361 名年龄在 18 岁及以上的急性 TBI 患者在头部外伤后 24 小时内就诊于急诊室，需要进行非对比头部 CT 检查以进行临床评估。
设计
多中心前瞻性队列研究。
主要观察指标
血管危险因素（高血压、糖尿病、高血脂和吸烟）通过自我或代理报告和病历回顾在基线时进行评估。主要结局指标是 6 个月后的格拉斯哥结局量表-扩展 TBI 版本（GOSE-TBI）。次要 6 个月结局指标包括 Rivermead 脑震荡后症状问卷（RPQ）、生活满意度量表（SWLS）和 18 项简明症状量表全球严重程度指数（BSI-18-GSI）。
结果
参与者的平均年龄为 42 岁，31%为女性，16%为黑人。目前吸烟是最常见的血管危险因素（29%），其次是高血压（17%）、糖尿病（8%）和高血脂（6%）。吸烟是所有 4 项结局指标评分恶化的唯一危险因素。高血压和糖尿病与 RPQ 评分恶化相关，高血压与 BSI-18-GSI 评分恶化相关（均 P<0.05）。与无血管危险因素的个体相比，有 1 种但无 2 种或更多种血管危险因素的个体的 GOSE-TBI 和 SWLS 评分明显较差，而血管危险因素负担较高与 RPQ 和 BSI-18-GSI 评分恶化显著相关。
结论
我们的研究发现，损伤前血管危险因素，尤其是吸烟，与 TBI 后结局较差有关。积极治疗损伤后血管危险因素可能是改善 TBI 结局的有前途的策略。
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