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Cerebral perfusion pressure, microdialysis biochemistry and clinical outcome in patients with traumatic brain injury.

Paraforou T, Paterakis K, Fountas K, Paraforos G, Chovas A, Tasiou A, Mpakopoulou M, Papadopoulos D, Karavellis A, Komnos A - BMC Res Notes (2011)

Bottom Line: No patient with a favorable outcome had a CPP lower than 75 mmHg or Glycerol concentration and L/P ratio greater than 72 mmol/l and 37 respectively.Data regarding L/P ratio and Glycerol concentration were statistically significant at p = 0.05 when patients with favorable and unfavorable outcome were compared.In a logistic regression model adjusted for age, sex and Glasgow Coma Scale on admission, a CPP greater than 75 mmHg was marginally statistically significantly related to outcome at 6 months after injury.

View Article: PubMed Central - HTML - PubMed

Affiliation: General Hospital of Larissa, Larissa, Greece. akomnos@yahoo.com.

ABSTRACT

Background: Traumatic Brain Injury (TBI) is a major cause of death and disability. It has been postulated that brain metabolic status, intracranial pressure (ICP) and cerebral perfusion pressure (CPP) are related to patients' outcome. The aim of this study was to investigate the relationship between CPP, ICP and microdialysis parameters and clinical outcome in TBIs.

Results: Thirty four individuals with severe brain injury hospitalized in an intensive care unit participated in this study. Microdialysis data were collected, along with ICP and CPP values. Glasgow Outcome Scale (GOS) was used to evaluate patient outcome at 6 months after injury. Fifteen patients with a CPP greater than 75 mmHg, L/P ratio lower than 37 and Glycerol concentration lower than 72 mmol/l had an excellent outcome (GOS 4 or 5), as opposed to the remaining 19 patients. No patient with a favorable outcome had a CPP lower than 75 mmHg or Glycerol concentration and L/P ratio greater than 72 mmol/l and 37 respectively. Data regarding L/P ratio and Glycerol concentration were statistically significant at p = 0.05 when patients with favorable and unfavorable outcome were compared. In a logistic regression model adjusted for age, sex and Glasgow Coma Scale on admission, a CPP greater than 75 mmHg was marginally statistically significantly related to outcome at 6 months after injury.

Conclusions: Patients with favorable outcome had certain common features in terms of microdialysis parameters and CPP values. An individualized approach regarding CPP levels and cut -off points for Glycerol concentration and L/P ratio are proposed.

No MeSH data available.


Related in: MedlinePlus

ROCs for CPP, Glycerol and L/P values.
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Figure 1: ROCs for CPP, Glycerol and L/P values.

Mentions: The study of L/P and Glucerol concentration distributions revealed that no patient with favorable prognosis had either an L/P ratio or a Glycerol concentration greater than 37 and 72 mmol/l respectively. Regarding CPP distribution, no patient with a favorable prognosis had a CPP value lower than 75. Six patients with an unfavorable outcome had an L/P value and a Glycerol concentration lower than 37 and 72 mmol/l respectively. Five patients with an unfavorable outcome had a CPP value lower than 75 mmHg (Table 3). If the aforementioned critical values were regarded as cut-off points, meaningful statistical results were produced for L/P, CPP and glycerol values. A statistically significant difference was established between the favorable and unfavorable prognosis groups regarding L/P and Glycerol, while a marginal significance was found for CPP. It is noted, that all 15 patients with a favorable outcome had L/P ratio < 37, CPP ≥ 75 mmHg and glycerol < 72 mmol/l. ROCs for Glycerol, L/P and CPP are presented in Figure 1. Regarding the other parameters, 3 patients with favorable outcome had a Glucose concentration greater than 2.75, 3 patients had a PbtO2 greater then 37, while 1 patient had an ICP value greater than 60 mmHg (data not shown). The mean value of PbtO2 was slightly higher in patients with favorable outcome exhibiting a broader standard deviation. However, no statistically significant difference was observed between the two groups (favorable outcome group: 32.33 ± 14.93, unfavorable outcome group: 29.51 ± 5.91, F = 1.2, t = -0.17,p = 0.864). Variables that were statistically significantly related to outcome in the univariate analysis were included in a logistic regression model. After adjusting for age, sex and GCS on admission, the odds for the patients with a CPP greater than 75 mmHg were 11.1 higher for favorable outcome at 6 months after the injury (p = 0.052-Table 4).


Cerebral perfusion pressure, microdialysis biochemistry and clinical outcome in patients with traumatic brain injury.

Paraforou T, Paterakis K, Fountas K, Paraforos G, Chovas A, Tasiou A, Mpakopoulou M, Papadopoulos D, Karavellis A, Komnos A - BMC Res Notes (2011)

ROCs for CPP, Glycerol and L/P values.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3275520&req=5

Figure 1: ROCs for CPP, Glycerol and L/P values.
Mentions: The study of L/P and Glucerol concentration distributions revealed that no patient with favorable prognosis had either an L/P ratio or a Glycerol concentration greater than 37 and 72 mmol/l respectively. Regarding CPP distribution, no patient with a favorable prognosis had a CPP value lower than 75. Six patients with an unfavorable outcome had an L/P value and a Glycerol concentration lower than 37 and 72 mmol/l respectively. Five patients with an unfavorable outcome had a CPP value lower than 75 mmHg (Table 3). If the aforementioned critical values were regarded as cut-off points, meaningful statistical results were produced for L/P, CPP and glycerol values. A statistically significant difference was established between the favorable and unfavorable prognosis groups regarding L/P and Glycerol, while a marginal significance was found for CPP. It is noted, that all 15 patients with a favorable outcome had L/P ratio < 37, CPP ≥ 75 mmHg and glycerol < 72 mmol/l. ROCs for Glycerol, L/P and CPP are presented in Figure 1. Regarding the other parameters, 3 patients with favorable outcome had a Glucose concentration greater than 2.75, 3 patients had a PbtO2 greater then 37, while 1 patient had an ICP value greater than 60 mmHg (data not shown). The mean value of PbtO2 was slightly higher in patients with favorable outcome exhibiting a broader standard deviation. However, no statistically significant difference was observed between the two groups (favorable outcome group: 32.33 ± 14.93, unfavorable outcome group: 29.51 ± 5.91, F = 1.2, t = -0.17,p = 0.864). Variables that were statistically significantly related to outcome in the univariate analysis were included in a logistic regression model. After adjusting for age, sex and GCS on admission, the odds for the patients with a CPP greater than 75 mmHg were 11.1 higher for favorable outcome at 6 months after the injury (p = 0.052-Table 4).

Bottom Line: No patient with a favorable outcome had a CPP lower than 75 mmHg or Glycerol concentration and L/P ratio greater than 72 mmol/l and 37 respectively.Data regarding L/P ratio and Glycerol concentration were statistically significant at p = 0.05 when patients with favorable and unfavorable outcome were compared.In a logistic regression model adjusted for age, sex and Glasgow Coma Scale on admission, a CPP greater than 75 mmHg was marginally statistically significantly related to outcome at 6 months after injury.

View Article: PubMed Central - HTML - PubMed

Affiliation: General Hospital of Larissa, Larissa, Greece. akomnos@yahoo.com.

ABSTRACT

Background: Traumatic Brain Injury (TBI) is a major cause of death and disability. It has been postulated that brain metabolic status, intracranial pressure (ICP) and cerebral perfusion pressure (CPP) are related to patients' outcome. The aim of this study was to investigate the relationship between CPP, ICP and microdialysis parameters and clinical outcome in TBIs.

Results: Thirty four individuals with severe brain injury hospitalized in an intensive care unit participated in this study. Microdialysis data were collected, along with ICP and CPP values. Glasgow Outcome Scale (GOS) was used to evaluate patient outcome at 6 months after injury. Fifteen patients with a CPP greater than 75 mmHg, L/P ratio lower than 37 and Glycerol concentration lower than 72 mmol/l had an excellent outcome (GOS 4 or 5), as opposed to the remaining 19 patients. No patient with a favorable outcome had a CPP lower than 75 mmHg or Glycerol concentration and L/P ratio greater than 72 mmol/l and 37 respectively. Data regarding L/P ratio and Glycerol concentration were statistically significant at p = 0.05 when patients with favorable and unfavorable outcome were compared. In a logistic regression model adjusted for age, sex and Glasgow Coma Scale on admission, a CPP greater than 75 mmHg was marginally statistically significantly related to outcome at 6 months after injury.

Conclusions: Patients with favorable outcome had certain common features in terms of microdialysis parameters and CPP values. An individualized approach regarding CPP levels and cut -off points for Glycerol concentration and L/P ratio are proposed.

No MeSH data available.


Related in: MedlinePlus