Autoregulatory-guided management in traumatic brain injury: does age matter?

IF 1.9 3区 医学 Q3 CLINICAL NEUROLOGY
Teodor Svedung Wettervik, Erta Beqiri, Anders Hånell, Stefan Yu Bögli, Ihsane Olakorede, Xuhang Chen, Adel Helmy, Andrea Lavinio, Peter J. Hutchinson, Peter Smielewski
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Abstract

Background

Although older traumatic brain injury (TBI) patients often exhibit cerebral autoregulatory impairment with high pressure reactivity index (PRx), the role of autoregulatory-guided management in these patients remains elusive. In this study, we aimed to explore if age affected the prognostic role of the autoregulatory variables, PRx and the PRx-derived optimal cerebral perfusion pressure (CPPopt), in a large TBI cohort.

Methods

In this observational study, 550 TBI patients who had been treated in the neurocritical care unit, Addenbrooke’s Hospital, Cambridge, UK, between 2002 and 2022 with available data on age, intracranial pressure monitoring, and outcome (Glasgow Outcome Scale [GOS]) were included. The patients were classified into three age groups; youth and early adulthood (16–39 years), middle adulthood (40–59 years), and senior adulthood (60 years and above). Autoregulatory variables were studied in relation to outcome using heatmaps. Multivariate logistic regressions of mortality and favourable outcome (GOS 4 to 5) were performed with PRx and ΔCPPopt (CPP-CPPopt) in addition to baseline variables.

Results

TBI patients in the senior adulthood group exhibited higher PRx and lower ICP than younger patients. There was a transition towards worse outcome with higher PRx in heatmaps for all age groups. The combination of high PRx together with low CPP or negative ΔCPPopt was particularly associated with lower GOS. In multivariate logistic regressions, higher PRx remained independently associated with higher mortality and lower rate of favourable outcome in the senior adulthood cohort. There was a transition towards worse outcome for negative ΔCPPopt for all age groups, but it did not reach statistical significance for the senior adulthood group.

Conclusions

PRx was found to be an independent outcome predictor and influenced the safe and dangerous CPP and ΔCPPopt interval for all age groups. Thus, TBI patients older than 60 years may also benefit from autoregulatory-guided management and should not necessarily be excluded from future trials on such therapeutic strategies.

外伤性脑损伤的自我调节引导管理:年龄重要吗?
尽管老年创伤性脑损伤(TBI)患者经常表现出大脑自身调节功能障碍并伴有高压反应指数(PRx),但自我调节引导治疗在这些患者中的作用仍然难以确定。在这项研究中,我们旨在探讨年龄是否影响自身调节变量PRx和PRx衍生的最佳脑灌注压(CPPopt)在一个大型TBI队列中的预后作用。方法在这项观察性研究中,纳入了2002年至2022年间在英国剑桥阿登布鲁克医院(Addenbrooke’s Hospital)神经危重症监护室接受治疗的550例TBI患者,这些患者的年龄、颅内压监测和预后(格拉斯哥结局量表[GOS])均有可用数据。患者分为3个年龄组;青年和成年早期(16-39岁),中年(40-59岁)和老年(60岁及以上)。使用热图研究与结果相关的自调节变量。除基线变量外,还使用PRx和ΔCPPopt (cppp - cppopt)对死亡率和有利结局(GOS 4至5)进行多因素logistic回归。结果老年成年组stbi患者PRx较高,ICP较年轻组低。在所有年龄组的热图中,PRx越高,结果越差。高PRx合并低CPP或负ΔCPPopt尤其与较低的GOS相关。在多变量logistic回归中,在老年成年队列中,较高的PRx仍然与较高的死亡率和较低的有利转归率独立相关。在所有年龄组中,负ΔCPPopt都有向更差结果的转变,但在老年成年组中没有达到统计学意义。结论sprx是一个独立的预后预测因子,影响各年龄组的安全、危险CPP和ΔCPPopt时间间隔。因此,60岁以上的TBI患者也可以从自我调节引导的管理中获益,不必排除在此类治疗策略的未来试验之外。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Acta Neurochirurgica
Acta Neurochirurgica 医学-临床神经学
CiteScore
4.40
自引率
4.20%
发文量
342
审稿时长
1 months
期刊介绍: The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.
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