Prognostic value of global deep white matter DTI metrics for 1-year outcome prediction in ICU traumatic brain injury patients: an MRI-COMA and CENTER-TBI combined study,Intensive Care Medicine

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Prognostic value of global deep white matter DTI metrics for 1-year outcome prediction in ICU traumatic brain injury patients: an MRI-COMA and CENTER-TBI combined study
Intensive Care Medicine ( IF 27.1 ) Pub Date : 2022-12-14 , DOI: 10.1007/s00134-021-06583-z
Louis Puybasset _{1,

2,

3,

4} , Vincent Perlbarg ₅ , Jean Unrug _{1,

2} , Didier Cassereau ₂ , Damien Galanaud _{2,

6} , Grégory Torkomian ₁ , Valentine Battisti ₁ , Muriel Lefort ₂ , Lionel Velly _{7,

8} , Vincent Degos _{4,

9,

10} , Guiseppe Citerio _{11,

12} , Éléonore Bayen _{2,

13} , Mélanie Pelegrini-Issac ₂ ,

Affiliation

Neurosurgical Intensive Care Unit, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France.
Laboratoire d'Imagerie Biomédicale (LIB), Sorbonne Université, CNRS, INSERM, Paris, France.
Department of Anesthesiology and Intensive Care, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
Clinical Research Group 29, Sorbonne Université, Paris, France.
BrainTale SAS, Paris, France.
Department of Neuroradiology, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France.
Department of Anesthesiology and Critical Care Medicine, University Hospital Timone, AP-HM, Aix Marseille University, Marseille, France.
CNRS, Institute of Neuroscience Timone, UMR7289, Aix Marseille University, Marseille, France.
Department of Anesthesia, Critical Care and Peri-Operative Medicine, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France.
INSERM UMR 1141, Paris, France.
Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Neurointensive Care Unit, Department of Emergency and Urgency, ASST-Monza, San Gerardo Hospital, Monza, Italy.
Rehabilitation Unit, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France.

Purpose

A reliable tool for outcome prognostication in severe traumatic brain injury (TBI) would improve intensive care unit (ICU) decision-making process by providing objective information to caregivers and family. This study aimed at designing a new classification score based on magnetic resonance (MR) diffusion metrics measured in the deep white matter between day 7 and day 35 after TBI to predict 1-year clinical outcome.

Methods

Two multicenter cohorts (29 centers) were used. MRI-COMA cohort (NCT00577954) was split into MRI-COMA-Train (50 patients enrolled between 2006 and mid-2014) and MRI-COMA-Test (140 patients followed up in clinical routine from 2014) sub-cohorts. These latter patients were pooled with 56 ICU patients (enrolled from 2014 to 2020) from CENTER-TBI cohort (NCT02210221). Patients were dichotomised depending on their 1-year Glasgow outcome scale extended (GOSE) score: GOSE 1–3, unfavorable outcome (UFO); GOSE 4–8, favorable outcome (FO). A support vector classifier incorporating fractional anisotropy and mean diffusivity measured in deep white matter, and age at the time of injury was developed to predict whether the patients would be either UFO or FO.

Results

The model achieved an area under the ROC curve of 0.93 on MRI-COMA-Train training dataset, and 49% sensitivity for 96.8% specificity in predicting UFO and 58.5% sensitivity for 97.1% specificity in predicting FO on the pooled MRI-COMA-Test and CENTER-TBI validation datasets.

Conclusion

The model successfully identified, with a specificity compatible with a personalized decision-making process in ICU, one in two patients who had an unfavorable outcome at 1 year after the injury, and two-thirds of the patients who experienced a favorable outcome.

中文翻译：

全球深部白质 DTI 指标对 ICU 创伤性脑损伤患者 1 年结果预测的预后价值：MRI-COMA 和 CENTER-TBI 联合研究

目的

一种可靠的严重创伤性脑损伤 (TBI) 结果预测工具将通过向护理人员和家人提供客观信息来改善重症监护病房 (ICU) 的决策过程。本研究旨在设计一个新的分类评分，该评分基于 TBI 后第 7 天至第 35 天在深部白质中测量的磁共振 (MR) 扩散指标，以预测 1 年的临床结果。

方法

使用了两个多中心队列（29 个中心）。MRI-COMA 队列 (NCT00577954) 分为 MRI-COMA-Train（2006 年至 2014 年中期招募 50 名患者）和 MRI-COMA-Test（从 2014 年开始在临床常规中随访的 140 名患者）子队列。后面这些患者与来自 CENTER-TBI 队列 (NCT02210221) 的 56 名 ICU 患者（从 2014 年至 2020 年入组）合并。根据 1 年格拉斯哥结果量表扩展 (GOSE) 评分对患者进行二分法：GOSE 1-3，不良结果 (UFO)；GOSE 4-8，有利结果（FO）。开发了一个支持向量分类器，其中包含在深部白质中测量的分数各向异性和平均扩散率以及受伤时的年龄，以预测患者是 UFO 还是 FO。