Citation

Zeiler FA, Ercole A, Placek MM, Hutchinson PJ, Stocchetti N, Czosnyka M, Smieleweski P. J. Neurotrauma 2020; ePub(ePub): ePub.

Copyright

(Copyright © 2020, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2020.7249

PMID

32814492

Abstract

In traumatic brain injury (TBI), preliminary retrospective work on signal entropy suggests an association with global outcome. The goal of this study was to provide multi-center validation of the association between multi-scale entropy (MSE) of cardiovascular and cerebral physiologic signals, with 6-month outcome. Using the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) high-resolution intensive care unit (ICU) cohort, we selected patients with a minimum of 72 hours of physiologic recordings, and a documented 6-month Glasgow Outcome Scale Extended (GOSE) score. 10-second summary data for heart rate (HR), mean arterial pressure (MAP), intracranial pressure (ICP) and pulse amplitude of ICP (AMP), were derived across the first 72 hours of data. MSE complexity index (MSE-Ci) was determined for HR, MAP, ICP and AMP, with the association between MSE and dichotomized 6-month outcomes assessed using Mann-Whitney-U testing and logistic regression analysis. A total of 160 patients had a minimum of 72 hours of recording and a documented outcome. Decreased HR MSE-Ci (7.3 (IQR 5.4 to 10.2) vs. 5.1 (IQR 3.1 to 7.0); p=0.002), lower ICP MSE-Ci (11.2 (IQR 7.5 to 14.2) vs. 7.3 (IQR 6.1 to 11.0); p=0.009) and lower AMP MSE-Ci (10.9 (IQR 8.0 to 13.7) vs. 8.7 (IQR 6.6 to 11.0); p=0.022), were associated with death. Similarly, lower HR MSE-Ci (8.0 (IQR 6.2 to 10.9) vs. 6.2 (IQR 3.9 to 8.7); p=0.003) and lower ICP MSE-Ci (11.4 (IQR 8.6 to 14.4) vs. 9.2 (IQR 6.0 to 13.5)), were associated with unfavourable outcome. Logistic regression analysis confirmed that lower HR MSE-Ci and ICP MSE-Ci were associated with death and unfavourable outcome at 6-months. These findings suggest that a reduction in cardiovascular and cerebrovascular system entropy is associated with worse outcomes. Further work in the field of signal complexity in TBI multi-modal monitoring is required.

Language: en

Keywords

ADULT BRAIN INJURY; HEAD TRAUMA; TRAUMATIC BRAIN INJURY; CBF autoregulation; VASCULAR REACTIVITY