Cerebrovascular Pressure Reactivity Has a Strong and Independent Association with Outcome in Children with Severe Traumatic Brain Injury∗

Claudia A. Smith; Ursula K. Rohlwink; Katya Mauff; Nqobile S. Thango; Thembani S. Hina; Shamiel Salie; Johannes M.N. Enslin; Anthony A. Figaji

doi:10.1097/CCM.0000000000005815

Cerebrovascular Pressure Reactivity Has a Strong and Independent Association with Outcome in Children with Severe Traumatic Brain Injury∗

Claudia A. Smith
, Ursula K. Rohlwink
, Katya Mauff
, Nqobile S. Thango
, Thembani S. Hina
, Shamiel Salie
, Johannes M.N. Enslin
, Anthony A. Figaji

Epidemiology

University of Cape Town
The Francis Crick Institute

Research output: Contribution to journal › Article › Academic › peer-review

28 Citations (Scopus)

108 Downloads (Pure)

Abstract

OBJECTIVES: To examine cerebrovascular pressure reactivity index (PRx) in a large cohort of children with severe traumatic brain injury (sTBI) in association with physiologic variables and outcome. DESIGN: Retrospective observational cohort study. SETTING: Red Cross War Memorial Children's Hospital in Cape Town, South Africa. PATIENTS: Pediatric (≤ 14 yr old) sTBI patients with intracranial pressure (ICP) monitoring (postresuscitation Glasgow Coma Score [Glasgow Coma Scale (GCS)] of ≤ 8). MEASUREMENTS AND MAIN RESULTS: Data were analyzed from ICM+ files sampled at 100Hz. PRx (a mathematical indicator of pressure reactivity) was calculated as a moving correlation coefficient between ICP and mean arterial pressure (MAP) as previously described. Associations between PRx, age, GCS, ICP, MAP, and cerebral perfusion pressure (CPP) were examined with summary measures and correlation analysis using high-frequency data. Associations between PRx and mortality/outcome were examined with multivariable logistic regression analysis and the prognostic ability of PRx with receiver operating characteristic (ROCs) curves. The dataset included over 1.7 million minutes (28,634 hr) of MAP and ICP data in 196 children. The series mortality was 10.7% (21/196), and unfavorable outcome 29.6% (58/196). PRx had a moderate positive correlation with ICP (r = 0.44; p < 0.001), a moderate negative correlation with CPP (r = -0.43; p < 0.001), and a weak negative correlation with MAP (r = -0.21; p = 0.004). PRx was consistently higher in patients with poor outcome and had a strong, independent association with mortality (ROC area under the curve = 0.91). A PRx threshold of 0.25 showed the best predictive ability for mortality. CONCLUSIONS: This is the largest cohort of children with PRx analysis of cerebrovascular reactivity to date. PRx had a strong association with outcome that was independent of ICP, CPP, GCS, and age. The data suggest that impaired autoregulation is an independent factor associated with poor outcome and may be useful in directing clinical care.

Original language	English
Pages (from-to)	573-583
Number of pages	11
Journal	Critical Care Medicine
Volume	51
Issue number	5
DOIs	https://doi.org/10.1097/CCM.0000000000005815
Publication status	Published - 1 May 2023

Bibliographical note

Funding Information:
This work is based on research supported by the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation of South Africa (Grant No 64770), as well as by the South African Medical Research Council (SAMRC). The content and findings reported/ illustrated are the sole deduction, view and responsibility of the researcher and do not reflect the official position and sentiments of the SAMRC. Ms. Smith received funding from the National Research Foundation Studentship Grant, the University of Cape Town Vice Chancellor’s Research Scholarship and Academic Merit Scholarship for Master’s Degree and a travel grant, the ‘Des Fernandes Award’ from Del Khan Surgical Research Day. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.

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Cerebrovascular_Pressure_Reactivity_Has_a_Strong.3Final published version, 1.14 MBLicence: CC BY-NC-ND

Cite this

@article{f84621f25e3f4ed69553f31aa9ea80e2,

title = "Cerebrovascular Pressure Reactivity Has a Strong and Independent Association with Outcome in Children with Severe Traumatic Brain Injury∗",

abstract = "OBJECTIVES: To examine cerebrovascular pressure reactivity index (PRx) in a large cohort of children with severe traumatic brain injury (sTBI) in association with physiologic variables and outcome. DESIGN: Retrospective observational cohort study. SETTING: Red Cross War Memorial Children's Hospital in Cape Town, South Africa. PATIENTS: Pediatric (≤ 14 yr old) sTBI patients with intracranial pressure (ICP) monitoring (postresuscitation Glasgow Coma Score [Glasgow Coma Scale (GCS)] of ≤ 8). MEASUREMENTS AND MAIN RESULTS: Data were analyzed from ICM+ files sampled at 100Hz. PRx (a mathematical indicator of pressure reactivity) was calculated as a moving correlation coefficient between ICP and mean arterial pressure (MAP) as previously described. Associations between PRx, age, GCS, ICP, MAP, and cerebral perfusion pressure (CPP) were examined with summary measures and correlation analysis using high-frequency data. Associations between PRx and mortality/outcome were examined with multivariable logistic regression analysis and the prognostic ability of PRx with receiver operating characteristic (ROCs) curves. The dataset included over 1.7 million minutes (28,634 hr) of MAP and ICP data in 196 children. The series mortality was 10.7\% (21/196), and unfavorable outcome 29.6\% (58/196). PRx had a moderate positive correlation with ICP (r = 0.44; p < 0.001), a moderate negative correlation with CPP (r = -0.43; p < 0.001), and a weak negative correlation with MAP (r = -0.21; p = 0.004). PRx was consistently higher in patients with poor outcome and had a strong, independent association with mortality (ROC area under the curve = 0.91). A PRx threshold of 0.25 showed the best predictive ability for mortality. CONCLUSIONS: This is the largest cohort of children with PRx analysis of cerebrovascular reactivity to date. PRx had a strong association with outcome that was independent of ICP, CPP, GCS, and age. The data suggest that impaired autoregulation is an independent factor associated with poor outcome and may be useful in directing clinical care.",

author = "Smith, \{Claudia A.\} and Rohlwink, \{Ursula K.\} and Katya Mauff and Thango, \{Nqobile S.\} and Hina, \{Thembani S.\} and Shamiel Salie and Enslin, \{Johannes M.N.\} and Figaji, \{Anthony A.\}",

note = "Funding Information: This work is based on research supported by the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation of South Africa (Grant No 64770), as well as by the South African Medical Research Council (SAMRC). The content and findings reported/ illustrated are the sole deduction, view and responsibility of the researcher and do not reflect the official position and sentiments of the SAMRC. Ms. Smith received funding from the National Research Foundation Studentship Grant, the University of Cape Town Vice Chancellor{\textquoteright}s Research Scholarship and Academic Merit Scholarship for Master{\textquoteright}s Degree and a travel grant, the {\textquoteleft}Des Fernandes Award{\textquoteright} from Del Khan Surgical Research Day. The remaining authors have disclosed that they do not have any potential conflicts of interest. Publisher Copyright: {\textcopyright} 2023 Lippincott Williams and Wilkins. All rights reserved.",

year = "2023",

month = may,

day = "1",

doi = "10.1097/CCM.0000000000005815",

language = "English",

volume = "51",

pages = "573--583",

journal = "Critical Care Medicine",

issn = "0090-3493",

publisher = "Lippincott Williams \& Wilkins",

number = "5",

}

TY - JOUR

T1 - Cerebrovascular Pressure Reactivity Has a Strong and Independent Association with Outcome in Children with Severe Traumatic Brain Injury∗

AU - Smith, Claudia A.

AU - Rohlwink, Ursula K.

AU - Mauff, Katya

AU - Thango, Nqobile S.

AU - Hina, Thembani S.

AU - Salie, Shamiel

AU - Enslin, Johannes M.N.

AU - Figaji, Anthony A.

N1 - Funding Information: This work is based on research supported by the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation of South Africa (Grant No 64770), as well as by the South African Medical Research Council (SAMRC). The content and findings reported/ illustrated are the sole deduction, view and responsibility of the researcher and do not reflect the official position and sentiments of the SAMRC. Ms. Smith received funding from the National Research Foundation Studentship Grant, the University of Cape Town Vice Chancellor’s Research Scholarship and Academic Merit Scholarship for Master’s Degree and a travel grant, the ‘Des Fernandes Award’ from Del Khan Surgical Research Day. The remaining authors have disclosed that they do not have any potential conflicts of interest. Publisher Copyright: © 2023 Lippincott Williams and Wilkins. All rights reserved.

PY - 2023/5/1

Y1 - 2023/5/1

N2 - OBJECTIVES: To examine cerebrovascular pressure reactivity index (PRx) in a large cohort of children with severe traumatic brain injury (sTBI) in association with physiologic variables and outcome. DESIGN: Retrospective observational cohort study. SETTING: Red Cross War Memorial Children's Hospital in Cape Town, South Africa. PATIENTS: Pediatric (≤ 14 yr old) sTBI patients with intracranial pressure (ICP) monitoring (postresuscitation Glasgow Coma Score [Glasgow Coma Scale (GCS)] of ≤ 8). MEASUREMENTS AND MAIN RESULTS: Data were analyzed from ICM+ files sampled at 100Hz. PRx (a mathematical indicator of pressure reactivity) was calculated as a moving correlation coefficient between ICP and mean arterial pressure (MAP) as previously described. Associations between PRx, age, GCS, ICP, MAP, and cerebral perfusion pressure (CPP) were examined with summary measures and correlation analysis using high-frequency data. Associations between PRx and mortality/outcome were examined with multivariable logistic regression analysis and the prognostic ability of PRx with receiver operating characteristic (ROCs) curves. The dataset included over 1.7 million minutes (28,634 hr) of MAP and ICP data in 196 children. The series mortality was 10.7% (21/196), and unfavorable outcome 29.6% (58/196). PRx had a moderate positive correlation with ICP (r = 0.44; p < 0.001), a moderate negative correlation with CPP (r = -0.43; p < 0.001), and a weak negative correlation with MAP (r = -0.21; p = 0.004). PRx was consistently higher in patients with poor outcome and had a strong, independent association with mortality (ROC area under the curve = 0.91). A PRx threshold of 0.25 showed the best predictive ability for mortality. CONCLUSIONS: This is the largest cohort of children with PRx analysis of cerebrovascular reactivity to date. PRx had a strong association with outcome that was independent of ICP, CPP, GCS, and age. The data suggest that impaired autoregulation is an independent factor associated with poor outcome and may be useful in directing clinical care.

AB - OBJECTIVES: To examine cerebrovascular pressure reactivity index (PRx) in a large cohort of children with severe traumatic brain injury (sTBI) in association with physiologic variables and outcome. DESIGN: Retrospective observational cohort study. SETTING: Red Cross War Memorial Children's Hospital in Cape Town, South Africa. PATIENTS: Pediatric (≤ 14 yr old) sTBI patients with intracranial pressure (ICP) monitoring (postresuscitation Glasgow Coma Score [Glasgow Coma Scale (GCS)] of ≤ 8). MEASUREMENTS AND MAIN RESULTS: Data were analyzed from ICM+ files sampled at 100Hz. PRx (a mathematical indicator of pressure reactivity) was calculated as a moving correlation coefficient between ICP and mean arterial pressure (MAP) as previously described. Associations between PRx, age, GCS, ICP, MAP, and cerebral perfusion pressure (CPP) were examined with summary measures and correlation analysis using high-frequency data. Associations between PRx and mortality/outcome were examined with multivariable logistic regression analysis and the prognostic ability of PRx with receiver operating characteristic (ROCs) curves. The dataset included over 1.7 million minutes (28,634 hr) of MAP and ICP data in 196 children. The series mortality was 10.7% (21/196), and unfavorable outcome 29.6% (58/196). PRx had a moderate positive correlation with ICP (r = 0.44; p < 0.001), a moderate negative correlation with CPP (r = -0.43; p < 0.001), and a weak negative correlation with MAP (r = -0.21; p = 0.004). PRx was consistently higher in patients with poor outcome and had a strong, independent association with mortality (ROC area under the curve = 0.91). A PRx threshold of 0.25 showed the best predictive ability for mortality. CONCLUSIONS: This is the largest cohort of children with PRx analysis of cerebrovascular reactivity to date. PRx had a strong association with outcome that was independent of ICP, CPP, GCS, and age. The data suggest that impaired autoregulation is an independent factor associated with poor outcome and may be useful in directing clinical care.

UR - https://www.scopus.com/pages/publications/85152602021

U2 - 10.1097/CCM.0000000000005815

DO - 10.1097/CCM.0000000000005815

M3 - Article

C2 - 36790173

AN - SCOPUS:85152602021

SN - 0090-3493

VL - 51

SP - 573

EP - 583

JO - Critical Care Medicine

JF - Critical Care Medicine

IS - 5

ER -

Cerebrovascular Pressure Reactivity Has a Strong and Independent Association with Outcome in Children with Severe Traumatic Brain Injury∗

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