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Association between cerebrovascular reactivity in adult traumatic brain injury and improvement in patient outcome over time: an exploratory analysis

  • Original Article - Brain trauma
  • Published:
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Abstract

Background

Impaired cerebrovascular reactivity following moderate/severe traumatic brain injury (TBI) has emerged as a key potential driver of morbidity and mortality. However, the major contributions to the literature so far have been solely focused on single point measures of long-term outcome. Therefore, it remains unknown whether cerebrovascular reactivity impairment, during the acute phase of TBI, is associated with failure to improve in outcome across time.

Methods

Cerebrovascular reactivity was measured using three intracranial pressure-based surrogate metrics. For each patient, % time spent above various literature-defined thresholds was calculated. Patients were dichotomized based on outcome transition into Improved vs Not Improved between 1 and 3 months, 3 and 6 months, and 1 and 6 months, based on the Glasgow Outcome Scale-Extended (GOSE). Univariate and multivariable logistic regression analyses were performed, adjusting for the International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) variables.

Results

Seventy-eight patients from the Winnipeg Acute TBI Database were included in this study. On univariate logistic regression analysis, higher % time with cerebrovascular reactivity metrics above clinically defined thresholds was associated with a lack of clinical improvement between 1 and 3 months and 1 and 6 months post injury (p < 0.05). These relationships held true on multivariable logistic regression analysis.

Conclusion

Our study demonstrates that impaired cerebrovascular reactivity, during the acute phase of TBI, is associated with failure to improve clinically over time. These preliminary findings highlight the significance that cerebrovascular reactivity monitoring carries in outcome recovery association in moderate/severe TBI.

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Funding

KYS is supported through the University of Manitoba BSc in Medicine program and a Richard Hoeschen Memorial Award. LF is supported through the University of Manitoba—Department of Surgery GFT Research Grant, the University of Manitoba Office of Research Services (ORS)—University Research Grant Program (URGP), the University of Manitoba Biomedical Engineering Fellowship Program, and the Edward R. Toporeck Graduate Fellowship in Engineering. AG is supported through the University of Manitoba Clinician Investigator Program, the University of Manitoba Dean’s Fellowship, the Manitoba Medical Services Foundation Research and Education Fellowship, and the R. Samuel McLaughlin Research Fellowship. ASS is supported through the UMGSA Scholarship at the University of Manitoba, NSERC (RGPIN-2022–03621), and the University of Manitoba Graduate Enhancement of Tri-Agency Stipend (GETS) program. CB is supported through the Centre on Aging at the University of Manitoba. FAZ receives research support from the Manitoba Public Insurance (MPI) Professorship in Neuroscience, the MPI TBI Research Operating Fund, the Health Sciences Centre Foundation Winnipeg, the Natural Sciences and Engineering Research Council of Canada (NSERC) (RGPIN-2022–03621, ALLRP-576386-22, and DGECR-2022–00260), the Canada Foundation for Innovation (CFI) (Project #: 38583), Research Manitoba (Grant #: 3906), and the University of Manitoba VPRI Research Investment Fund (RIF).

Author information

Authors and Affiliations

  1. Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, Canada

    Kevin Y. Stein, Logan Froese, Amanjyot Singh Sainbhi & Frederick A. Zeiler

  2. Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada

    Alwyn Gomez & Frederick A. Zeiler

  3. Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada

    Alwyn Gomez, Carleen Batson & Frederick A. Zeiler

  4. Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, Canada

    Francois Mathieu

  5. Division of Anaesthesia, Department of Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK

    Frederick A. Zeiler

  6. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

    Frederick A. Zeiler

Authors
  1. Kevin Y. Stein
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  2. Logan Froese
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  3. Alwyn Gomez
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  4. Amanjyot Singh Sainbhi
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  5. Carleen Batson
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  6. Francois Mathieu
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  7. Frederick A. Zeiler
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Contributions

KYS was involved in data acquisition, data interpretation, formal data analysis, and manuscript preparation. LF was involved in data acquisition, data interpretation, formal data analysis, and manuscript preparation. AG was involved in data acquisition, data interpretation, and manuscript preparation. ASS was involved in data acquisition, data interpretation, and manuscript preparation. CB was involved in data acquisition, data interpretation, and manuscript preparation. FM was involved in data acquisition, data interpretation, and manuscript preparation. FAZ was involved in conceptualization, data acquisition, data interpretation, formal data analysis, manuscript preparation, and general supervision.

Corresponding author

Correspondence to Kevin Y. Stein.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

Ethics approval pertaining to all aspects of data collection for the prospectively maintained Winnipeg Acute TBI Database has been obtained from the University of Manitoba Health Research Ethics Board (H2017:181, H2017:188). Approval to retrospectively access this database for physiologic/outcome analysis was also granted (H2020:118). This study was performed in accordance with the ethical standards outlined in the 1964 Declaration of Helsinki and its later amendments. Given that all data is collected in an entirely de-identified fashion (with no means to trace data back to an individual patient), collection of this data has been approved through a waived consent model by the research ethics board and provincial patient privacy offices of Manitoba.

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Stein, K.Y., Froese, L., Gomez, A. et al. Association between cerebrovascular reactivity in adult traumatic brain injury and improvement in patient outcome over time: an exploratory analysis. Acta Neurochir 164, 3107–3118 (2022). https://doi.org/10.1007/s00701-022-05366-9

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  • DOI: https://doi.org/10.1007/s00701-022-05366-9

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