Association of Age and Sex With Multi-Modal Cerebral Physiology in Adult Moderate/Severe Traumatic Brain Injury: A Narrative Overview and Future Avenues for Personalized Approaches

Batson, Carleen; Gomez, Alwyn; Sainbhi, Amanjyot Singh; Froese, Logan; Zeiler, Frederick A.

doi:10.3389/fphar.2021.676154

Cited by 5 publications

(3 citation statements)

References 129 publications

(281 reference statements)

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“…Baune et al's study found that in elderly patients, higher concentrations of IL-6 with chronic low-level systemic inflammation may be associated with increased mortality ( 34 ). The aging process strengthens the chronic immune response in the brain (leading to chronic cerebrovascular changes, such as amyloid protein deposition, resulting in increased leukocytes), which may be linked to an ongoing dysfunction in the central nervous system and degeneration ( 26 , 35 ). Large cohort studies have demonstrated that men and older patients with moderate/severe TBI have worse long-term outcomes ( 35 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, further research is needed to investigate whether the neuroinflammatory reaction of systemic inflammation conditions causes damage to the nervous system. Baune et al's study found that in elderly patients, higher concentrations of IL-6 with chronic low-level systemic inflammation may be associated with increased mortality (34). The aging process strengthens the chronic immune response in the Clinical nomogram models were used to examine the relationship between baseline health status and future outcomes.…”

Section: Discussionmentioning

confidence: 99%

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The establishment and validation of a prediction model for traumatic intracranial injury patients: a reliable nomogram

Chen,

Jin,

Zeng

et al. 2023

Front. Neurol.

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ObjectiveTraumatic brain injury (TBI) leads to death and disability. This study developed an effective prognostic nomogram for assessing the risk factors for TBI mortality.MethodData were extracted from an online database called “Multiparameter Intelligent Monitoring in Intensive Care IV” (MIMIC IV). The ICD code obtained data from 2,551 TBI persons (first ICU stay, >18 years old) from this database. R divided samples into 7:3 training and testing cohorts. The univariate analysis determined whether the two cohorts differed statistically in baseline data. This research used forward stepwise logistic regression after independent prognostic factors for these TBI patients. The optimal variables were selected for the model by the optimal subset method. The optimal feature subsets in pattern recognition improved the model prediction, and the minimum BIC forest of the high-dimensional mixed graph model achieved a better prediction effect. A nomogram-labeled TBI-IHM model containing these risk factors was made by nomology in State software. Least Squares OLS was used to build linear models, and then the Receiver Operating Characteristic (ROC) curve was plotted. The TBI-IHM nomogram model's validity was determined by receiver operating characteristic curves (AUCs), correction curve, Hosmer-Lemeshow test, integrated discrimination improvement (IDI), net reclassification improvement (NRI), and decision-curve analysis (DCA).ResultThe eight features with a minimal BIC model were mannitol use, mechanical ventilation, vasopressor use, international normalized ratio, urea nitrogen, respiratory rate, and cerebrovascular disease. The proposed nomogram (TBI-IHM model) was the best mortality prediction model, with better discrimination and superior model fitting for severely ill TBI patients staying in ICU. The model's receiver operating characteristic curve (ROC) was the best compared to the seven other models. It might be clinically helpful for doctors to make clinical decisions.ConclusionThe proposed nomogram (TBI-IHM model) has significant potential as a clinical utility in predicting mortality in TBI patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The establishment and validation of a prediction model for traumatic intracranial injury patients: a reliable nomogram

Chen,

Jin,

Zeng

et al. 2023

Front. Neurol.

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show abstract

“…The data were then further categorized into subgroups based on demographic profiles. Evaluation of the subgroups included only age < 60 vs. age ≥ 60 and sex, based on past work [ 33 , 43 ]. Like the full group analysis, for each comparison, a Wilcoxon signed-ranked test was performed between the pre- and post-windows with Bonferroni correction to adjust for multiple comparisons.…”

Section: Methodsmentioning

confidence: 99%

Temporal relationship between vasopressor and sedative administration and cerebrovascular response in traumatic brain injury: a time-series analysis

Froese

Gomez

Sainbhi

et al. 2023

ICMx

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Background Although vasopressor and sedative agents are commonly used within the intensive care unit to mediate systemic and cerebral physiology, the full impact such agents have on cerebrovascular reactivity remains unclear. Using a prospectively maintained database of high-resolution critical care and physiology, the time-series relationship between vasopressor/sedative administration, and cerebrovascular reactivity was interrogated. Cerebrovascular reactivity was assessed through intracranial pressure and near infrared spectroscopy measures. Using these derived measures, the relationship between hourly dose of medication and hourly index values could be evaluated. The individual medication dose change and their corresponding physiological response was compared. Given the high number of doses of propofol and norepinephrine, a latent profile analysis was used to identify any underlying demographic or variable relationships. Finally, using time-series methodologies of Granger causality and vector impulse response functions, the relationships between the cerebrovascular reactivity derived variables were compared. Results From this retrospective observational study of 103 TBI patients, the evaluation between the changes in vasopressor or sedative agent dosing and the previously described cerebral physiologies was completed. The assessment of the physiology pre/post infusion agent change resulted in similar overall values (Wilcoxon signed-ranked p value > 0.05). Time series methodologies demonstrated that the basic physiological relationships were identical before and after an infusion agent was changed (Granger causality demonstrated the same directional impact in over 95% of the moments, with response function being graphically identical). Conclusions This study suggests that overall, there was a limited association between the changes in vasopressor or sedative agent dosing and the previously described cerebral physiologies including that of cerebrovascular reactivity. Thus, current regimens of administered sedative and vasopressor agents appear to have little to no impact on cerebrovascular reactivity in TBI.

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

et al. 2022

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Association of Age and Sex With Multi-Modal Cerebral Physiology in Adult Moderate/Severe Traumatic Brain Injury: A Narrative Overview and Future Avenues for Personalized Approaches

Cited by 5 publications

References 129 publications

The establishment and validation of a prediction model for traumatic intracranial injury patients: a reliable nomogram

The establishment and validation of a prediction model for traumatic intracranial injury patients: a reliable nomogram

Temporal relationship between vasopressor and sedative administration and cerebrovascular response in traumatic brain injury: a time-series analysis

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

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