Novel index for predicting mortality during the first 24 hours after traumatic brain injury

Hakseung Kim, Hack Jin Lee, Young Tak Kim, Yunsik Son, Peter Smielewski, Marek Czosnyka, Dong Joo Kim

Research output: Contribution to journalArticle

Abstract

OBJECTIVE Failure of cerebral autoregulation and subsequent hypoperfusion is common during the acute phase of traumatic brain injury (TBI). The cerebrovascular pressure-reactivity index (PRx) indirectly reflects cerebral autoregulation and has been used to derive optimal cerebral perfusion pressure (CPP). This study provides a method for the use of a combination of PRx, CPP, and intracranial pressure (ICP) to better evaluate the extent of cerebral hypoperfusion during the first 24 hours after TBI, allowing for a more accurate prediction of mortality risk. METHODS Continuous ICP and arterial blood pressure (ABP) signals acquired from 295 TBI patients during the first 24 hours after admission were retrospectively analyzed. The CPP at the lowest PRx was determined as the optimal CPP (CPPopt). The duration of a severe hypoperfusion event (dHP) was defined as the cumulative time that the PRx was > 0.2 and the CPP was < 70 mm Hg with the addition of intracranial hypertension (ICP > 20 or > 22 mm Hg). The outcome was determined as 6-month mortality. RESULTS The cumulative duration of PRx > 0.2 and CPP < 70 mm Hg exhibited a significant association with mortality (p < 0.001). When utilized with basic clinical information available during the first 24 hours after admission (i.e., Glasgow Coma Scale score, age, and mean ICP), a dHP > 25 minutes yielded a significant predictive capacity for mortality (p < 0.05, area under the curve [AUC] = 0.75). The parameter was particularly predictive of mortality for patients with a mean ICP > 20 or > 22 mm Hg (AUC = 0.81 and 0.87, respectively). CONCLUSIONS A short duration (25 minutes) of severe hypoperfusion, evaluated as lowered CPP during worsened cerebrovascular reactivity during the 1st day after TBI, is highly indicative of mortality.

Original languageEnglish
Pages (from-to)1887-1895
Number of pages9
JournalJournal of Neurosurgery
Volume131
Issue number6
DOIs
Publication statusPublished - 2019 Jan 1

Keywords

  • Cerebral autoregulation
  • Cerebral perfusion pressure
  • Cerebrovascular reactivity
  • Neurocritical care
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Fingerprint Dive into the research topics of 'Novel index for predicting mortality during the first 24 hours after traumatic brain injury'. Together they form a unique fingerprint.

  • Cite this