Failure of cerebral autoregulation has been linked to unfavorable outcome after traumatic brain injury (TBI). Preliminary evidence from a small, retrospective, single-center analysis suggests that autoregulatory dysfunction may be associated with traumatic lesion expansion, particularly for pericontusional edema. The goal of this study was to further explore these associations using prospective, multi-center data from the Collaborative European Neurotrauma Effectiveness Research in TBI (CENTER-TBI) and to further explore the relationship between autoregulatory failure, lesion progression, and patient outcome. A total of 88 subjects from the CENTER-TBI High Resolution ICU Sub-Study cohort were included. All patients had an admission computed tomography (CT) scan and early repeat scan available, as well as high-frequency neurophysiological recordings covering the between-scan interval. Using a novel, semiautomated approach at lesion segmentation, we calculated absolute changes in volume of contusion core, pericontusional edema, and extra-axial hemorrhage between the imaging studies. We then evaluated associations between cerebrovascular reactivity metrics and radiological lesion progression using mixed-model regression. Analyses were adjusted for baseline covariates and non-neurophysiological factors associated with lesion growth using multi-variate methods. Impairment in cerebrovascular reactivity was significantly associated with progression of pericontusional edema and, to a lesser degree, intraparenchymal hemorrhage. In contrast, there were no significant associations with extra-axial hemorrhage. The strongest relationships were observed between RAC-based metrics and edema formation. Pulse amplitude index showed weaker, but consistent, associations with contusion growth. Cerebrovascular reactivity metrics remained strongly associated with lesion progression after taking into account contributions from non-neurophysiological factors and mean cerebral perfusion pressure. Total hemorrhagic core and edema volumes on repeat CT were significantly larger in patients who were deceased at 6 months, and the amount of edema was greater in patients with an unfavourable outcome (Glasgow Outcome Scale-Extended 1–4). Our study suggests associations between autoregulatory failure, traumatic edema progression, and poor outcome. This is in keeping with findings from a single-center retrospective analysis, providing multi-center prospective data to support those results.

中文翻译：

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急性创伤性脑损伤患者脑血管反应性测量与颅内病变进展之间的关系：一项 CENTER-TBI 研究。

脑自动调节的失败与创伤性脑损伤 (TBI) 后的不良结果有关。一项小型、回顾性、单中心分析的初步证据表明，自动调节功能障碍可能与创伤性病灶扩大有关，尤其是对于痱子周围水肿。本研究的目的是使用来自 TBI 欧洲神经创伤有效性合作研究 (CENTER-TBI) 的前瞻性多中心数据进一步探索这些关联，并进一步探索自动调节失败、病变进展和患者预后之间的关系。共包括来自 CENTER-TBI 高分辨率 ICU 子研究队列的 88 名受试者。所有患者都有入院计算机断层扫描 (CT) 扫描和早期重复扫描可用，以及涵盖扫描间隔的高频神经生理学记录。使用一种新颖的半自动方法进行病灶分割，我们计算了影像学研究之间挫伤核心体积、挫伤周围水肿和轴外出血的绝对变化。然后，我们使用混合模型回归评估了脑血管反应性指标与放射学病变进展之间的关联。使用多变量方法针对基线协变量和与病变生长相关的非神经生理学因素调整分析。脑血管反应性受损与痱子周围水肿的进展显着相关，并在较小程度上与脑实质内出血有关。相比之下，与轴外出血没有显着关联。在基于 RAC 的指标和水肿形成之间观察到最强的关系。脉搏幅度指数显示出与挫伤生长较弱但一致的关联。在考虑到非神经生理因素和平均脑灌注压的影响后，脑血管反应性指标仍然与病变进展密切相关。6 个月时死亡的患者在重复 CT 上的总出血核心和水肿体积显着更大，并且在预后不良的患者中水肿量更大（格拉斯哥结局量表扩展 1-4）。我们的研究表明自动调节失败、创伤性水肿进展和不良预后之间存在关联。这与单中心回顾性分析的结果一致，