Journal
ACTA NEUROCHIRURGICA
Volume 161, Issue 7, Pages 1275-1284Publisher
SPRINGER WIEN
DOI: 10.1007/s00701-019-03915-3
Keywords
Compensatory reserve; Intracranial pressure; Outcome; Weighted ICP
Categories
Funding
- European Union 7th Framework program (EC grant) [602150]
- Hannelore Kohl Stiftung (Germany)
- OneMind (USA)
- Integra LifeSciences Corporation (USA)
- National Institute for Health Research (NIHR, UK)
- Cambridge Biomedical Research Centre at the Cambridge University Hospitals NHS Foundation Trust
- NIHR Clinical Research network
- Cambridge Commonwealth Trust Scholarship
- Royal College of Surgeons of Canada -Harry S. Morton Travelling Fellowship in Surgery
- University of Manitoba Thorlakson Chair in Surgical Research Establishment Fund
- University of Manitoba Research Investment Fund (RIF)
- University of Manitoba Rudy Falk Clinician-Scientist Professorship Award
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BackgroundCompensatory-reserve-weighted intracranial pressure (wICP) has recently been suggested as a supplementary measure of intracranial pressure (ICP) in adult traumatic brain injury (TBI), with a single-center study suggesting an association with mortality at 6months. No multi-center studies exist to validate this relationship. The goal was to compare wICP to ICP for association with outcome in a multi-center TBI cohort.MethodsUsing the Collaborative European Neuro Trauma Effectiveness Research in TBI (CENTER-TBI) high-resolution intensive care unit (ICU) cohort, we derived ICP and wICP (calculated as wICP=(1-RAP)xICP; where RAP is the compensatory reserve index derived from the moving correlation between pulse amplitude of ICP and ICP). Various univariate logistic regression models were created comparing ICP and wICP to dichotomized outcome at 6 to 12months, based on Glasgow Outcome ScoreExtended (GOSE) (alive/deadGOSE 2/GOSE=1; favorable/unfavorableGOSE 5 to 8/GOSE 1 to 4, respectively). Models were compared using area under the receiver operating curves (AUC) and p values.ResultswICP displayed higher AUC compared to ICP on univariate regression for alive/dead outcome compared to mean ICP (AUC 0.712, 95% CI 0.615-0.810, p=0.0002, and AUC 0.642, 95% CI 0.538-746, p<0.0001, respectively; no significant difference on Delong's test), and for favorable/unfavorable outcome (AUC 0.627, 95% CI 0.548-0.705, p=0.015, and AUC 0.495, 95% CI 0.413-0.577, p=0.059; significantly different using Delong's test p=0.002), with lower wICP values associated with improved outcomes (p<0.05 for both). These relationships on univariate analysis held true even when comparing the wICP models with those containing both ICP and RAP integrated area under the curve over time (p<0.05 for all via Delong's test).ConclusionsCompensatory-reserve-weighted ICP displays superior outcome association for both alive/dead and favorable/unfavorable dichotomized outcomes in adult TBI, through univariate analysis. Lower wICP is associated with better global outcomes. The results of this study provide multi-center validation of those seen in a previous single-center study.
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