Initial intracranial pressure as a prognosticator in head-injured patients undergoing decompressive craniectomy

Hua Liu; Rong Xu; Jian Yang; Guanghui Ren; Shengxue He

doi:10.18632/oncotarget.11632

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Research Papers:

Initial intracranial pressure as a prognosticator in head-injured patients undergoing decompressive craniectomy

Hua Liu, Rong Xu, Jian Yang, Guanghui Ren and Shengxue He _

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Oncotarget. 2016; 7:62657-62663. https://doi.org/10.18632/oncotarget.11632

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Abstract

Hua Liu1,*, Rong Xu2,*, Jian Yang1, Guanghui Ren1, Shengxue He3

1Department of Neurosurgery, The First People’s Hospital of Kunshan Affiliated with Jiangsu University, Suzhou, Jiangsu, China

2Department of Pediatric Surgery, The First People’s Hospital of Kunshan Affiliated with Jiangsu University, Suzhou, Jiangsu, China

3Department of Neurosurgery, The Affiliated Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China

*These authors have contributed equally to this work

Correspondence to:

Shengxue He, email: [email protected]

Keywords: initial intracranial pressure, traumatic brain injury, decompressive craniectomy

Received: June 06, 2016 Accepted: August 15, 2016 Published: August 26, 2016

ABSTRACT

Purpose: To examine the prognostic discrimination and prediction of initial intracranial pressure (ICP) in patients with traumatic brain injury (TBI) undergoing decompressive craniectomy (DC).

Results: The relationship between the initial ICP value and prognosis was quantified, and higher values indicated worse patient outcomes. Univariate analysis showed that the initial ICP value was significantly associated with mortality (odds ratio: 1.272, 95% confidence interval: 1.116-1.449; P<0.001) and unfavorable outcomes (odds ratio: 1.256, 95% confidence interval: 1.160-1.360; P<0.001). After adjustment for related outcome predictors of TBI in multivariate regression, the initial ICP value remained an independent predictor of unfavorable outcomes (odds ratio: 1.251, 95% confidence interval: 1.140-1.374; P=0.015) and mortality (odds ratio: 1.162, 95% confidence interval: 1.093-1.321; P=0.019).

Methods: A retrospective study was conducted in 133 TBI patients after DC. Initial ICP was defined as the first ICP recorded during surgery. Mortality and Glasgow Outcome Scale score at the end of follow-up were used as outcome measures. Unfavorable and favorable outcomes were classified by a Glasgow Outcome Scale score of 1 to 3 and 4 to 5, respectively. We used binary logistic and proportional odds regression for prognostic analyses.

Conclusion: For TBI patients undergoing DC, the initial ICP value provides great prognostic discrimination and is an independent predictor of unfavorable outcomes and mortality. We suggest that the initial ICP be included as a prognosticator in the overall assessment of prognosis of head-injured patients after DC.

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Research Papers:

Initial intracranial pressure as a prognosticator in head-injured patients undergoing decompressive craniectomy

Abstract