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老年创伤性脑损伤患者不良结局的相关因素:来自该研究项目的分析

Factors associated with unfavorable outcomes in older patients with traumatic brain injury: analysis from the research program.

作者信息

Chen Zhangying, Wang Zihao, Mentis Alexios-Fotios A, Stey Anne M, Schwulst Steven J

机构信息

Department of Surgery, Division of Trauma and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.

Driskill Graduate Program in Life Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.

出版信息

Front Neurol. 2024 Nov 19;15:1452995. doi: 10.3389/fneur.2024.1452995. eCollection 2024.

Abstract

Traumatic brain injury (TBI) afflicts approximately 70 million people worldwide annually, with patients aged 65 years and older accounting for an increasing proportion of TBI patients. Older patients also experience increased morbidity and mortality post-TBI compared to their younger counterparts. Nevertheless, clinical trials often exclude older TBI patients, and age-specific TBI treatment is lacking. We hypothesized that the genotype and age-associated comorbidities, such as heart disease, are associated with unfavorable outcomes following TBI in older patients. We utilized a dataset from the (AoU) to study this vulnerable population post-TBI. Launched by the National Institutes of Health (NIH), AoU is a nationwide prospective cohort study aiming to enroll 1 million or more individuals by emphasizing traditionally underrepresented populations in the United States. We defined patients diagnosed with post-concussion syndromes (PCS) as those with unfavorable TBI outcomes, and we also assessed the associations between PCS observed in older patients and different comorbidities variables/APOE genotypes via multiple logistic regression models. Consequently, APOE ε4 allele was strongly associated with PCS in patients aged 65 and older. Our findings provide direct evidence for developing better predictive tools and potentially improving the clinical guidance and management of older adults with TBI.

摘要

创伤性脑损伤(TBI)每年在全球影响约7000万人,65岁及以上的患者在TBI患者中所占比例日益增加。与年轻患者相比,老年患者在TBI后还会出现更高的发病率和死亡率。然而,临床试验通常将老年TBI患者排除在外,并且缺乏针对特定年龄的TBI治疗方法。我们假设,基因型和与年龄相关的合并症,如心脏病,与老年患者TBI后的不良预后相关。我们利用来自美国国立卫生研究院(NIH)发起的“所有人”(AoU)数据集来研究TBI后的这一脆弱人群。AoU是一项全国性前瞻性队列研究,旨在通过强调美国传统上代表性不足的人群招募100万或更多个体。我们将被诊断为脑震荡后综合征(PCS)的患者定义为TBI预后不良的患者,并且我们还通过多个逻辑回归模型评估了老年患者中观察到的PCS与不同合并症变量/载脂蛋白E(APOE)基因型之间的关联。因此,APOE ε4等位基因与65岁及以上患者的PCS密切相关。我们的研究结果为开发更好的预测工具以及潜在地改善老年TBI患者的临床指导和管理提供了直接证据。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6e14/11611856/f31704d095b1/fneur-15-1452995-g001.jpg

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