Spreading depolarisations and outcome after traumatic brain injury: a prospective observational study

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• 作者：Jed A Hartings DrPhD^a ;   ; ^{jed.hartings@uc.edu} ; M Ross Bullock MD^b ; David O Okonkwo MD^c ; Lilian S Murray PhD^d ; Gordon D Murray PhD^e ; Martin Fabricius DMSc^f ; Andrew IR Maas MD^g ; Johannes Woitzik MD^h ;   ; ⁱ ; Oliver Sakowitz MD^j ; Bruce Mathern MD^k ; Bob Roozenbeek MD^g ;   ; ^l ; Hester Lingsma PhD^l ; Jens P Dreier MDⁱ ; Ava M Puccio PhD^c ; Lori A Shutter MD^a ; Clemens Pahl MD^m ; Anthony J Strong MDⁿ ; for the Co-Operative Study on Brain Injury Depolarisations
• 刊名：Lancet Neurology
• 出版年：2011
• 出版时间：December 2011
• 年：2011
• 卷：10
• 期：12
• 页码：1058-1064
• 全文大小：147 K

文摘

Summary

Background

Pathological waves of spreading mass neuronal depolarisation arise repeatedly in injured, but potentially salvageable, grey matter in 50?0 % of patients after traumatic brain injury (TBI). We aimed to ascertain whether spreading depolarisations are independently associated with unfavourable neurological outcome.

Methods

We did a prospective, observational, multicentre study at seven neurological centres. We enrolled 109 adults who needed neurosurgery for acute TBI. Spreading depolarisations were monitored by electrocorticography during intensive care and were classified as cortical spreading depression (CSD) if they took place in spontaneously active cortex or as isoelectric spreading depolarisation (ISD) if they took place in isoelectric cortex. Investigators who treated patients and assessed outcome were masked to electrocorticographic results. Scores on the extended Glasgow outcome scale at 6 months were fitted to a multivariate model by ordinal regression. Prognostic score (based on variables at admission, as validated by the IMPACT studies) and spreading depolarisation category (none, CSD only, or at least one ISD) were assessed as outcome predictors.

Findings

Six individuals were excluded because of poor-quality electrocorticography. A total of 1328 spreading depolarisations arose in 58 (56 % ) patients. In 38 participants, all spreading depolarisations were classified as CSD; 20 patients had at least one ISD. By multivariate analysis, both prognostic score (p=0¡¤0009) and spreading depolarisation category (p=0¡¤0008) were significant predictors of neurological outcome. CSD and ISD were associated with an increased risk of unfavourable outcome (common odds ratios 1¡¤56 [95 % CI 0¡¤72?¡¤37] and 7¡¤58 [2¡¤64?1¡¤8], respectively). Addition of depolarisation category to the regression model increased the proportion of variance in outcome that could be attributed to predictors from 9 % to 22 % , compared with the prognostic score alone.

Interpretation

Spreading depolarisations were associated with unfavourable outcome, after controlling for conventional prognostic variables. The possibility that spreading depolarisations have adverse effects on the traumatically injured brain, and therefore might be a target in the treatment of TBI, deserves further research.

Funding

US Army CDMRP PH/TBI research programme.