Compensatory-reserve-weighted intracranial pressure versus intracranial pressure for outcome association in adult traumatic brain injury: a CENTER-TBI validation study
Creators: name: Zeiler, Frederick A.
name: Ercole, Ari
name: Cabeleira, Manuel
name: Beqiri, Erta
name: Zoerle, Tommaso
name: Carbonara, Marco
name: Stocchetti, Nino
name: Menon, David K.
name: Smielewski, Peter
name: Czosnyka, Marek
name: Anke, Audny
name: Beer, Ronny
name: Bellander, Bo-Michael
name: Buki, Andras
name: Chevallard, Giorgio
name: Chieregato, Arturo
name: Citerio, Giuseppe
name: Czeiter, Endre
name: Depreitere, Bart
name: Eapen, George
name: Frisvold, Shirin
name: Helbok, Raimund
name: Jankowski, Stefan
name: Kondziella, Daniel
name: Koskinen, Lars-Owe
name: Meyfroidt, Geert
name: Moeller, Kirsten
name: Nelson, David
name: Piippo-Karjalainen, Anna
name: Radoi, Andreea
name: Ragauskas, Arminas
name: Raj, Rahul
name: Rhodes, Jonathan
name: Rocka, Saulius
name: Rossaint, Rolf
name: Sahuquillo, Juan
name: Sakowitz, Oliver
name: Stevanovic, Ana
name: Sundström, Nina
name: Takala, Riikka
name: Tamosuitis, Tomas
name: Tenovuo, Olli
name: Vajkoczy, Peter
name: Vargiolu, Alessia
name: Vilcinis, Rimantas
name: Wolf, Stefan
name: Younsi, Alexander
Publisher: name: Apollo - University of Cambridge Repository
Year: 2019
Subjects: Original Article - Brain trauma
Brain trauma
Compensatory reserve
Intracranial pressure
Outcome
Weighted ICP

description: Abstract: Background: Compensatory-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 6 months. 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. Methods: Using 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) × ICP; 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 12 months, based on Glasgow Outcome Score—Extended (GOSE) (alive/dead—GOSE ≥ 2/GOSE = 1; favorable/unfavorable—GOSE 5 to 8/GOSE 1 to 4, respectively). Models were compared using area under the receiver operating curves (AUC) and p values. Results: wICP 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 &lt; 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 &lt; 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 &lt; 0.05 for all via Delong’s test). Conclusions: Compensatory-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.