Frank H. Netter M.D. School of Medicine, Quinnipiac University, 830 Orange Street, New Haven, CT, 06511, USA.
Division of Biostatistics, Department of Public Health Sciences, Davis Clinical and Translational Science Center, University of California, 2921 Stockton Blvd., Suite 1400, Sacramento, CA, 95817, USA.
Neurocrit Care. 2023 Feb;38(1):149-157. doi: 10.1007/s12028-022-01587-z. Epub 2022 Sep 1.
The presence of traumatic intraventricular hemorrhage (tIVH) following traumatic brain injury (TBI) is associated with worse neurological outcome. The mechanisms by which patients with tIVH have worse outcome are not fully understood and research is ongoing, but foundational studies that explore prognostic factors within tIVH populations are also lacking. This study aimed to further identify and characterize demographic and clinical variables within a subset of patients with TBI and tIVH that may be implicated in tIVH outcome.
In this observational study, we reviewed a large prospective TBI database to determine variables present on admission that predicted neurological outcome 6 months after injury. A review of 7,129 patients revealed 211 patients with tIVH on admission and 6-month outcome data. Hypothesized risk factors were tested in univariate analyses with significant variables (p < 0.05) included in logistic and linear regression models. Following the addition of either the Rotterdam computed tomography or Glasgow Coma Scale (GCS) score, we employed a backward selection process to determine significant variables in each multivariate model.
Our study found that that hypotension (odds ratio [OR] = 0.35, 95% confidence interval [CI] = 0.13-0.94, p = 0.04) and the hemoglobin level (OR = 1.33, 95% CI = 1.09-1.63, p = 0.006) were significant predictors in the Rotterdam model, whereas only the hemoglobin level (OR = 1.29, 95% CI = 1.06-1.56, p = 0.01) was a significant predictor in the GCS model.
This study represents one of the largest investigations into prognostic factors for patients with tIVH and demonstrates that admission hemoglobin level and hypotension are associated with outcomes in this patient population. These findings add value to established prognostic scales, could inform future predictive modeling studies, and may provide potential direction in early medical management of patients with tIVH.
创伤性脑损伤（TBI）后出现创伤性脑室内出血（tIVH）与更差的神经结局相关。tIVH 患者结局更差的机制尚未完全阐明，且相关研究仍在进行，但也缺乏对 tIVH 人群中预后因素的基础研究。本研究旨在进一步确定和描述 TBI 合并 tIVH 患者亚组中可能与 tIVH 结局相关的人口统计学和临床变量。
在这项观察性研究中，我们回顾了一个大型前瞻性 TBI 数据库，以确定入院时存在的变量是否可预测损伤后 6 个月的神经结局。对 7129 例患者的回顾发现，入院时有 211 例患者存在 tIVH 且有 6 个月的结局数据。在单变量分析中测试了假设的危险因素，有显著意义的变量（p<0.05）纳入逻辑回归和线性回归模型。在添加 Rotterdam 计算机断层扫描或格拉斯哥昏迷量表（GCS）评分后，我们采用向后选择过程确定每个多变量模型中的显著变量。
我们的研究发现，低血压（比值比 [OR] = 0.35，95%置信区间 [CI] = 0.13-0.94，p = 0.04）和血红蛋白水平（OR = 1.33，95% CI = 1.09-1.63，p = 0.006）是 Rotterdam 模型中的显著预测因子，而只有血红蛋白水平（OR = 1.29，95% CI = 1.06-1.56，p = 0.01）是 GCS 模型中的显著预测因子。
本研究是对 tIVH 患者预后因素进行的最大规模研究之一，表明入院时的血红蛋白水平和低血压与该患者人群的结局相关。这些发现增加了既定预后量表的价值，可为未来的预测模型研究提供信息，并可能为 tIVH 患者的早期医学管理提供潜在方向。
