Near-Infrared Spectroscopy-derived Cerebral Autoregulation Indices Independently Predict Clinical Outcome in Acutely Ill Comatose Patients

Lucia Rivera Lara, Romergryko Geocadin, Andres Zorrilla-Vaca, Ryan Healy, Batya R. Radzik, Caitlin Palmisano, Mirinda A. White, Dhaval Sha, Luciano Ponce-Mejia, Charles Brown, Charles Hogue, Wendy C Ziai

Research output: Contribution to journalArticle

Abstract

Objective: Outcome prediction in comatose patients with acute brain injury remains challenging. Regional cerebral oxygenation (rSO 2 ) derived from near-infrared spectroscopy (NIRS) is a surrogate for cerebral blood flow and can be used to calculate cerebral autoregulation (CA) continuously at the bedside from the derived cerebral oximetry index (COx). We hypothesized that COx derived thresholds for CA are associated with outcomes in patients with acute coma from neurological injury. Methods: A prospective cohort study was conducted in 88 acutely comatose adults with heterogenous brain injury diagnoses who were continuously monitored with COx for up to 3 consecutive days. Multivariable logistic regression was performed to investigate association between averaged COx and short (in-hospital and 3 mo) and long-term (6 mo) outcomes. Results: Six month mortality rate was 62%. Median COx in nonsurvivors at hospital discharge was 0.082 [interquartile range, IQR: 0.045 to 0.160] compared with 0.042 [IQR: -0.005 to 0.110] in survivors (P=0.012). At 6 months, median COx was 0.075 [IQR: 0.27 to 0.158] in nonsurvivors compared with 0.029 [IQR: -0.015 to 0.077] in survivors (P=0.02). In the multivariable logistic regression model adjusted for confounders, average COx ≥0.05 was associated with both in-hospital mortality (adjusted odds ratio [OR]=2.9, 95% confidence interval [CI]=1.15-7.33, P=0.02), mortality at 6 months (adjusted OR=4.4, 95% CI=1.41-13.7, P=0.01), and severe disability (modified Rankin Score ≥4) at 6 months (adjusted OR=4.4, 95% CI=1.07-17.8, P=0.04). Area under the receiver operating characteristic curve for predicting mortality and severe disability at 6 months were 0.783 and 0.825, respectively. Conclusions: Averaged COx ≥0.05 is independently associated with short and long-term mortality and long-term severe disability in acutely comatose adults with neurological injury. We propose that COx ≥0.05 represents an accurate threshold to predict long-term functional outcome in acutely comatose adults.

Original languageEnglish (US)
JournalJournal of Neurosurgical Anesthesiology
DOIs
StatePublished - Jan 1 2019

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Oximetry
Near-Infrared Spectroscopy
Coma
Homeostasis
Mortality
Logistic Models
Odds Ratio
Confidence Intervals
Brain Injuries
Survivors
Cerebrovascular Circulation
Wounds and Injuries
Hospital Mortality
ROC Curve
Cohort Studies
Prospective Studies

Keywords

  • cerebral autoregulation
  • cerebral oximetry
  • cerebral perfusion
  • near-infrared spectroscopy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Near-Infrared Spectroscopy-derived Cerebral Autoregulation Indices Independently Predict Clinical Outcome in Acutely Ill Comatose Patients. / Rivera Lara, Lucia; Geocadin, Romergryko; Zorrilla-Vaca, Andres; Healy, Ryan; Radzik, Batya R.; Palmisano, Caitlin; White, Mirinda A.; Sha, Dhaval; Ponce-Mejia, Luciano; Brown, Charles; Hogue, Charles; Ziai, Wendy C.

In: Journal of Neurosurgical Anesthesiology, 01.01.2019.

Research output: Contribution to journalArticle

Rivera Lara, Lucia ; Geocadin, Romergryko ; Zorrilla-Vaca, Andres ; Healy, Ryan ; Radzik, Batya R. ; Palmisano, Caitlin ; White, Mirinda A. ; Sha, Dhaval ; Ponce-Mejia, Luciano ; Brown, Charles ; Hogue, Charles ; Ziai, Wendy C. / Near-Infrared Spectroscopy-derived Cerebral Autoregulation Indices Independently Predict Clinical Outcome in Acutely Ill Comatose Patients. In: Journal of Neurosurgical Anesthesiology. 2019.
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title = "Near-Infrared Spectroscopy-derived Cerebral Autoregulation Indices Independently Predict Clinical Outcome in Acutely Ill Comatose Patients",
abstract = "Objective: Outcome prediction in comatose patients with acute brain injury remains challenging. Regional cerebral oxygenation (rSO 2 ) derived from near-infrared spectroscopy (NIRS) is a surrogate for cerebral blood flow and can be used to calculate cerebral autoregulation (CA) continuously at the bedside from the derived cerebral oximetry index (COx). We hypothesized that COx derived thresholds for CA are associated with outcomes in patients with acute coma from neurological injury. Methods: A prospective cohort study was conducted in 88 acutely comatose adults with heterogenous brain injury diagnoses who were continuously monitored with COx for up to 3 consecutive days. Multivariable logistic regression was performed to investigate association between averaged COx and short (in-hospital and 3 mo) and long-term (6 mo) outcomes. Results: Six month mortality rate was 62{\%}. Median COx in nonsurvivors at hospital discharge was 0.082 [interquartile range, IQR: 0.045 to 0.160] compared with 0.042 [IQR: -0.005 to 0.110] in survivors (P=0.012). At 6 months, median COx was 0.075 [IQR: 0.27 to 0.158] in nonsurvivors compared with 0.029 [IQR: -0.015 to 0.077] in survivors (P=0.02). In the multivariable logistic regression model adjusted for confounders, average COx ≥0.05 was associated with both in-hospital mortality (adjusted odds ratio [OR]=2.9, 95{\%} confidence interval [CI]=1.15-7.33, P=0.02), mortality at 6 months (adjusted OR=4.4, 95{\%} CI=1.41-13.7, P=0.01), and severe disability (modified Rankin Score ≥4) at 6 months (adjusted OR=4.4, 95{\%} CI=1.07-17.8, P=0.04). Area under the receiver operating characteristic curve for predicting mortality and severe disability at 6 months were 0.783 and 0.825, respectively. Conclusions: Averaged COx ≥0.05 is independently associated with short and long-term mortality and long-term severe disability in acutely comatose adults with neurological injury. We propose that COx ≥0.05 represents an accurate threshold to predict long-term functional outcome in acutely comatose adults.",
keywords = "cerebral autoregulation, cerebral oximetry, cerebral perfusion, near-infrared spectroscopy",
author = "{Rivera Lara}, Lucia and Romergryko Geocadin and Andres Zorrilla-Vaca and Ryan Healy and Radzik, {Batya R.} and Caitlin Palmisano and White, {Mirinda A.} and Dhaval Sha and Luciano Ponce-Mejia and Charles Brown and Charles Hogue and Ziai, {Wendy C}",
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doi = "10.1097/ANA.0000000000000589",
language = "English (US)",
journal = "Journal of Neurosurgical Anesthesiology",
issn = "0898-4921",
publisher = "Lippincott Williams and Wilkins",

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T1 - Near-Infrared Spectroscopy-derived Cerebral Autoregulation Indices Independently Predict Clinical Outcome in Acutely Ill Comatose Patients

AU - Rivera Lara, Lucia

AU - Geocadin, Romergryko

AU - Zorrilla-Vaca, Andres

AU - Healy, Ryan

AU - Radzik, Batya R.

AU - Palmisano, Caitlin

AU - White, Mirinda A.

AU - Sha, Dhaval

AU - Ponce-Mejia, Luciano

AU - Brown, Charles

AU - Hogue, Charles

AU - Ziai, Wendy C

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: Outcome prediction in comatose patients with acute brain injury remains challenging. Regional cerebral oxygenation (rSO 2 ) derived from near-infrared spectroscopy (NIRS) is a surrogate for cerebral blood flow and can be used to calculate cerebral autoregulation (CA) continuously at the bedside from the derived cerebral oximetry index (COx). We hypothesized that COx derived thresholds for CA are associated with outcomes in patients with acute coma from neurological injury. Methods: A prospective cohort study was conducted in 88 acutely comatose adults with heterogenous brain injury diagnoses who were continuously monitored with COx for up to 3 consecutive days. Multivariable logistic regression was performed to investigate association between averaged COx and short (in-hospital and 3 mo) and long-term (6 mo) outcomes. Results: Six month mortality rate was 62%. Median COx in nonsurvivors at hospital discharge was 0.082 [interquartile range, IQR: 0.045 to 0.160] compared with 0.042 [IQR: -0.005 to 0.110] in survivors (P=0.012). At 6 months, median COx was 0.075 [IQR: 0.27 to 0.158] in nonsurvivors compared with 0.029 [IQR: -0.015 to 0.077] in survivors (P=0.02). In the multivariable logistic regression model adjusted for confounders, average COx ≥0.05 was associated with both in-hospital mortality (adjusted odds ratio [OR]=2.9, 95% confidence interval [CI]=1.15-7.33, P=0.02), mortality at 6 months (adjusted OR=4.4, 95% CI=1.41-13.7, P=0.01), and severe disability (modified Rankin Score ≥4) at 6 months (adjusted OR=4.4, 95% CI=1.07-17.8, P=0.04). Area under the receiver operating characteristic curve for predicting mortality and severe disability at 6 months were 0.783 and 0.825, respectively. Conclusions: Averaged COx ≥0.05 is independently associated with short and long-term mortality and long-term severe disability in acutely comatose adults with neurological injury. We propose that COx ≥0.05 represents an accurate threshold to predict long-term functional outcome in acutely comatose adults.

AB - Objective: Outcome prediction in comatose patients with acute brain injury remains challenging. Regional cerebral oxygenation (rSO 2 ) derived from near-infrared spectroscopy (NIRS) is a surrogate for cerebral blood flow and can be used to calculate cerebral autoregulation (CA) continuously at the bedside from the derived cerebral oximetry index (COx). We hypothesized that COx derived thresholds for CA are associated with outcomes in patients with acute coma from neurological injury. Methods: A prospective cohort study was conducted in 88 acutely comatose adults with heterogenous brain injury diagnoses who were continuously monitored with COx for up to 3 consecutive days. Multivariable logistic regression was performed to investigate association between averaged COx and short (in-hospital and 3 mo) and long-term (6 mo) outcomes. Results: Six month mortality rate was 62%. Median COx in nonsurvivors at hospital discharge was 0.082 [interquartile range, IQR: 0.045 to 0.160] compared with 0.042 [IQR: -0.005 to 0.110] in survivors (P=0.012). At 6 months, median COx was 0.075 [IQR: 0.27 to 0.158] in nonsurvivors compared with 0.029 [IQR: -0.015 to 0.077] in survivors (P=0.02). In the multivariable logistic regression model adjusted for confounders, average COx ≥0.05 was associated with both in-hospital mortality (adjusted odds ratio [OR]=2.9, 95% confidence interval [CI]=1.15-7.33, P=0.02), mortality at 6 months (adjusted OR=4.4, 95% CI=1.41-13.7, P=0.01), and severe disability (modified Rankin Score ≥4) at 6 months (adjusted OR=4.4, 95% CI=1.07-17.8, P=0.04). Area under the receiver operating characteristic curve for predicting mortality and severe disability at 6 months were 0.783 and 0.825, respectively. Conclusions: Averaged COx ≥0.05 is independently associated with short and long-term mortality and long-term severe disability in acutely comatose adults with neurological injury. We propose that COx ≥0.05 represents an accurate threshold to predict long-term functional outcome in acutely comatose adults.

KW - cerebral autoregulation

KW - cerebral oximetry

KW - cerebral perfusion

KW - near-infrared spectroscopy

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