A pilot study evaluating a simple cardiac dysfunction score to predict complications and survival among critically-ill patients with traumatic brain injury

Gibbons, Patric; Goldberg, Robert J.; Muehlschlegel, Susanne

doi:10.1016/j.jcrc.2019.08.017

Cited by 5 publications

(6 citation statements)

References 24 publications

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“…Arrhythmias were present in one out of three patients and associated with in-hospital mortality. These findings are in line with cardiac dysfunction in patients with (isolated) TBI ( 13 , 24 ) and even higher than frequently observed ECG abnormalities in patients with ischemic (60%) or hemorrhagic stroke (50%) during admission, in which arrhythmias are associated with 3-month mortality ( 10 ).…”

Section: Discussionsupporting

confidence: 80%

“…Conduction disorders occurred in 45%, including mostly QTc-prolongation and arrhythmias, mostly of supraventricular origin, were present in 38% of patients. We observed more ECG abnormalities in comparison to findings of earlier studies, which might be related to their restricted age inclusion criteria (up to 50 years) and the presence of isolated TBI (24) or less severe head injured patients (13). These frequencies are also much higher compared to baseline ECG characteristics of the healthy adult patients from the LifeLines Cohort from our hospital with only 7.4% cardiac arrhythmias and 1.5% QTcprolongation, with the latter being more prevalent in men in line with findings from our study (25).…”

Section: Discussioncontrasting

confidence: 80%

“…Despite the growing literature on the peripheral interactions of TBI ( 12 ), only small case series or single cohort studies of patients with isolated TBI have highlighted the link between TBI and cardiac dysfunction, without data on early ECG abnormalities and outcome. The frequency of ECG abnormalities is related to Glasgow Coma Scale (GCS) on admission ( 13 ), but not to brain severity indices like computerized tomography (CT)-characteristics or ICP-treatment ( 14 , 15 ) ECG abnormalities in patients with TBI can be regarded as a secondary effect of brain injury or an expression of primary cardiac dysfunction, due to thoracic injury ( 16 , 17 ) and for that reason more difficult to interpret than in neurovascular diseases.…”

Section: Introductionmentioning

confidence: 99%

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The Association of Early Electrocardiographic Abnormalities With Brain Injury Severity and Outcome in Severe Traumatic Brain Injury

et al. 2021

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The aim of this study was to evaluate the frequency of electrocardiographic (ECG) abnormalities in the acute phase of severe traumatic brain injury (TBI) and the association with brain injury severity and outcome. In contrast to neurovascular diseases, sparse information is available on this issue. Data of adult patients with severe TBI admitted to the Intensive Care Unit (ICU) for intracranial pressure monitoring of a level-1 trauma center from 2002 till 2018 were analyzed. Patients with a cardiac history were excluded. An ECG recording was obtained within 24 h after ICU admission. Admission brain computerized tomography (CT)-scans were categorized by Marshall-criteria (diffuse vs. mass lesions) and for location of traumatic lesions. CT-characteristics and maximum Therapy Intensity Level (TILmax) were used as indicators for brain injury severity. We analyzed data of 198 patients, mean (SD) age of 40 ± 19 years, median GCS score 3 [interquartile range (IQR) 3–6], and 105 patients (53%) had thoracic injury. In-hospital mortality was 30%, with sudden death by cardiac arrest in four patients. The incidence of ECG abnormalities was 88% comprising ventricular repolarization disorders (57%) mostly with ST-segment abnormalities, conduction disorders (45%) mostly with QTc-prolongation, and arrhythmias (38%) mostly of supraventricular origin. More cardiac arrhythmias were observed with increased grading of diffuse brain injury (p = 0.042) or in patients treated with hyperosmolar therapy (TILmax) (65%, p = 0.022). No association was found between ECG abnormalities and location of brain lesions nor with thoracic injury. Multivariate analysis with baseline outcome predictors showed that cardiac arrhythmias were not independently associated with in-hospital mortality (p = 0.097). Only hypotension (p = 0.029) and diffuse brain injury (p = 0.017) were associated with in-hospital mortality. In conclusion, a high incidence of ECG abnormalities was observed in patients with severe TBI in the acute phase after injury. No association between ECG abnormalities and location of brain lesions or presence of thoracic injury was present. Cardiac arrhythmias were indicative for brain injury severity but not independently associated with in-hospital mortality. Therefore, our findings likely suggest that ECG abnormalities should be considered as cardiac mimicry representing the secondary effect of traumatic brain injury allowing for a more rationale use of neuroprotective measures.

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Section: Discussionsupporting

confidence: 80%

Section: Discussioncontrasting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

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The Association of Early Electrocardiographic Abnormalities With Brain Injury Severity and Outcome in Severe Traumatic Brain Injury

et al. 2021

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Section: Introductionmentioning

confidence: 99%

The Prognostic Value of Cardiac Troponin T in Different Age Groups of Traumatic Brain Injury Patients

Wang

Kang

2020

Preprint

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Background The cardiac dysfunction has been confirmed as a common non-neurological complication and associated with increased mortality in traumatic brain injury (TBI) patients. As a biological marker of cardiac injury, the cardiac troponin T (TnT) has been verified correlated with outcome of some non-traumatic brain injury patients. However, the prognostic value of TnT in TBI patients has not been clearly illustrated. We designed this study to explore the association between TnT and outcome of TBI patients in different age subgroups. Methods Patients diagnosed with TBI in a prospective critical care database were eligible for this study. Univariate logistic regression analysis was firstly performed to explore the relationship between included variables and mortality. Then, the real effect of TnT on outcome of different age subgroups was analyzed by multivariate logistic regression analysis adjusting the confounding effects of other significant risk factors. Finally, we draw receiver operating characteristic (ROC) curves to evaluate the prognostic value of TnT in different age groups of TBI patients. Results 520 patients were included in this study with mortality rate of 20.2%. There were 112 (21.5%) non-elderly patients (age < 65) and 408 (78.5%) elderly patients (age ≥ 65). Non-survivors had higher percentage of previous acute myocardial infarction (p = 0.019) and pupil no-reaction (p = 0.028; p = 0.011) than survivors. Survivors had higher GCS (p < 0.001) and lower TnT than non-survivors (p < 0.001). TnT was significantly associated with mortality in non-elderly patients (p = 0.031) but not in overall patients (p = 0.143) and elderly patients (p = 0.456) in multivariate logistic regression analysis. The AUC (area under the ROC curve) value of TnT in overall, non-elderly and elderly patients was 0.644, 0.693 and 0.632, respectively. Combining TnT with GCS increased the sensitivity of predicting mortality of both non-elderly and elderly TBI patients. Conclusion The prognostic value of TnT differed between elderly and non-elderly TBI patients. Level of TnT was associated with mortality of non-elderly TBI patients but not elderly patients. Combining the TnT with GCS could increase the sensitivity of prognosis evaluation.

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“…One of the most common non-neurological complications is cardiac injury, which was reported occurring in 22.3% of isolated severe TBI patients [6]. And it has been veri ed that cardiac dysfunction was positively correlated with brain injury severity and reduced inhospital survival in moderate to severe TBI patients [7]. Some indicators of cardiac dysfunction such as cardiac troponin, abnormalities of echocardiography and electrocardiogram have been explored and utilized in various clinical settings.…”

Section: Introductionmentioning

confidence: 99%

The prognostic value of cardiac troponin T in different age groups of traumatic brain injury patients

Wang

2021

Acta Neurol Belg

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BackgroundThe cardiac dysfunction has been con rmed as a common non-neurological complication and associated with increased mortality in traumatic brain injury (TBI) patients. As a biological marker of cardiac injury, the cardiac troponin T (TnT) has been veri ed correlated with outcome of some nontraumatic brain injury patients. However, the prognostic value of TnT in TBI patients has not been clearly illustrated. We designed this study to explore the association between TnT and outcome of TBI patients in different age subgroups. MethodsPatients diagnosed with TBI in a prospective critical care database were eligible for this study. Univariate logistic regression analysis was rstly performed to explore the relationship between included variables and mortality. Then, the real effect of TnT on outcome of different age subgroups was analyzed by multivariate logistic regression analysis adjusting the confounding effects of other signi cant risk factors. Finally, we draw receiver operating characteristic (ROC) curves to evaluate the prognostic value of TnT in different age groups of TBI patients.Results 520 patients were included in this study with mortality rate of 20.2%. There were 112 (21.5%) non-elderly patients (age < 65) and 408 (78.5%) elderly patients (age ≥ 65). Non-survivors had higher percentage of previous acute myocardial infarction (p = 0.019) and pupil no-reaction (p = 0.028; p = 0.011) than survivors. Survivors had higher GCS (p < 0.001) and lower TnT than non-survivors (p < 0.001). TnT was signi cantly associated with mortality in non-elderly patients (p = 0.031) but not in overall patients (p = 0.143) and elderly patients (p = 0.456) in multivariate logistic regression analysis. The AUC (area under the ROC curve) value of TnT in overall, non-elderly and elderly patients was 0.644, 0.693 and 0.632, respectively. Combining TnT with GCS increased the sensitivity of predicting mortality of both non-elderly and elderly TBI patients. ConclusionThe prognostic value of TnT differed between elderly and non-elderly TBI patients. Level of TnT was associated with mortality of non-elderly TBI patients but not elderly patients. Combining the TnT with GCS could increase the sensitivity of prognosis evaluation.

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A pilot study evaluating a simple cardiac dysfunction score to predict complications and survival among critically-ill patients with traumatic brain injury

Cited by 5 publications

References 24 publications

The Association of Early Electrocardiographic Abnormalities With Brain Injury Severity and Outcome in Severe Traumatic Brain Injury

The Association of Early Electrocardiographic Abnormalities With Brain Injury Severity and Outcome in Severe Traumatic Brain Injury

The Prognostic Value of Cardiac Troponin T in Different Age Groups of Traumatic Brain Injury Patients

The prognostic value of cardiac troponin T in different age groups of traumatic brain injury patients

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