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左眼和右眼神经瞳孔指数的差异与神经损伤患者的出院改良 Rankin 评分相关。

A differential of the left eye and right eye neurological pupil index is associated with discharge modified Rankin scores in neurologically injured patients.

机构信息

School of Optometry, University of California, Berkeley, CA, USA.

School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA.

出版信息

BMC Neurol. 2022 Jul 22;22(1):273. doi: 10.1186/s12883-022-02801-3.

DOI:10.1186/s12883-022-02801-3
PMID:35869429
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9306158/
Abstract

BACKGROUND

Automated infrared pupillometry (AIP) and the Neurological Pupil index (NPi) provide an objective means of assessing and trending the pupillary light reflex (PLR) across a broad spectrum of neurological diseases. NPi quantifies the PLR and ranges from 0 to 5; in healthy individuals, the NPi of both eyes is expected to be ≥ 3.0 and symmetric. AIP values demonstrate emerging value as a prognostic tool with predictive properties that could allow practitioners to anticipate neurological deterioration and recovery. The presence of an NPi differential (a difference ≥ 0.7 between the left and right eye) is a potential sign of neurological abnormality.

METHODS

We explored NPi differential by considering the modified Rankin Score at discharge (DC mRS) among patients admitted to neuroscience intensive care units (NSICU) of 4 U.S. and 1 Japanese hospitals and for two cohorts of brain injuries: stroke (including subarachnoid hemorrhage, intracerebral hemorrhage, acute ischemic stroke, and aneurysm, 1,200 total patients) and 185 traumatic brain injury (TBI) patients for a total of more than 54,000 pupillary measurements.

RESULTS

Stroke patients with at least 1 occurrence of an NPi differential during their NSICU stay have higher DC mRS scores (3.9) compared to those without an NPi differential (2.7; P < .001). Patients with TBI and at least 1 occurrence of an NPi differential during their NSICU stay have higher discharge modified Rankin Scale scores (4.1) compared to those without an NPi differential (2.9; P < .001). When patients experience both abnormalities, abnormal (NPi < 3.0) and an NPi differential, the latter has an anticipatory relationship with respect to the former (P < .001 for z-score skewness analysis). Finally, our analysis confirmed ≥ 0.7 as the optimal cutoff value for the NPi differential (AUC = 0.71, P < .001).

CONCLUSION

The NPi differential is an important factor that clinicians should consider when managing critically ill neurological injured patients admitted to the neurocritical care units.

TRIAL REGISTRATION

NCT02804438 , Date of Registration: June 17, 2016.

摘要

背景

自动红外瞳孔测量（AIP）和神经瞳孔指数（NPi）为评估和跟踪光反射（PLR）提供了一种客观的方法，涵盖了广泛的神经疾病谱。NPi 量化了 PLR，范围从 0 到 5；在健康个体中，双眼的 NPi 预计为≥3.0 和对称。AIP 值作为一种预后工具具有预测特性，表明它可能允许从业者预测神经恶化和恢复。NPi 差异（左眼和右眼之间的差异≥0.7）的存在是神经异常的潜在迹象。

方法

我们通过考虑美国 4 家医院和日本 1 家医院神经重症监护病房（NSICU）入院患者的改良 Rankin 评分出院时（DC mRS），以及两个脑损伤队列来探索 NPi 差异：中风（包括蛛网膜下腔出血、脑出血、急性缺血性中风和动脉瘤，共 1200 例患者）和 185 例创伤性脑损伤（TBI）患者，共超过 54000 次瞳孔测量。

结果

在 NSICU 期间至少发生 1 次 NPi 差异的中风患者的 DC mRS 评分（3.9）高于未发生 NPi 差异的患者（2.7；P<0.001）。在 NSICU 期间至少发生 1 次 NPi 差异的 TBI 患者的出院改良 Rankin 评分（4.1）高于未发生 NPi 差异的患者（2.9；P<0.001）。当患者同时出现两种异常时，异常（NPi<3.0）和 NPi 差异，后者与前者具有预测关系（z 得分偏度分析的 P<0.001）。最后，我们的分析证实，≥0.7 是 NPi 差异的最佳截断值（AUC=0.71，P<0.001）。

结论

NPi 差异是神经危重症患者管理中临床医生应考虑的一个重要因素。

试验注册

NCT02804438，登记日期：2016 年 6 月 17 日。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32dd/9306158/74ea4479c592/12883_2022_2801_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32dd/9306158/ba9a958cbd12/12883_2022_2801_Fig1_HTML.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32dd/9306158/ba9a958cbd12/12883_2022_2801_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32dd/9306158/c936d5e26fdd/12883_2022_2801_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32dd/9306158/45e4eb0e3801/12883_2022_2801_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32dd/9306158/c3e23ebf6325/12883_2022_2801_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32dd/9306158/74ea4479c592/12883_2022_2801_Fig5_HTML.jpg

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