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Impact of a Posttraumatic Cerebral Infarction on the Long-Term Outcome of Patients with Moderate and Severe Traumatic Brain Injuries: The Italian Multicenter Cohort INCEPT Study

35 Pages Posted: 28 Jan 2019

See all articles by Nazzareno Fagoni

Nazzareno Fagoni

University of Brescia

Simone Piva

ASST-Spedali Civili of Brescia

Lorenzo Pinelli

ASST-Spedali Civili of Brescia

Michele Frigerio

ASST-Spedali Civili of Brescia

Davide Tintori

ASST-Spedali Civili of Brescia

Maurizio Berardino

Città Della Salute e della Scienza

Andrea Bottazzi

Fondazione IRCCS Policlinico San Matteo

Livio Carnevale

Fondazione IRCCS Policlinico San Matteo

Tiziana Casalicchio

Ospedale San Giovanni Bosco

Carlo Alberto Castioni

Ospedale San Giovanni Bosco

Simona Cavallo

Azienda Ospedaliero-Universitaria

Davide Cerasti

University of Parma

Giuseppe Citerio

University of Milan - Bicocca

Marco Fontanella

University of Brescia

Serena Galiberti

Azienda Ospedaliera-Universitaria Pisana

Alan Girardini

Fondazione Poliambulanza

Paolo Gritti

Papa Giovanni XXIII Hospital

Ornella Manara

Papa Giovanni XXIII Hospital

Paolo Maremmani

Azienda Ospedaliera-Universitaria Pisana

Roberta Mazzani

Azienda Ospedaliera Universitaria Maggiore della Carità

Giuseppe Natalini

Fondazione Poliambulanza

Mirko Patassini

ASST - Monza

Maria Elena Perna

Ospedale San Giovanni Bosco

Ilaria Pesaresi

Azienda Ospedaliera-Universitaria Pisana

Danila Katia Radolovich

Fondazione IRCCS Policlinico San Matteo

Maurizio Saini

ASST - Monza

Roberto Stefini

Legnano Hospital

Cosetta Minelli

Imperial College London - National Heart and Lung Institute

Roberto Gasparotti

ASST-Spedali Civili of Brescia

Francesco A. Rasulo

ASST-Spedali Civili of Brescia

Nicola Latronico

ASST-Spedali Civili of Brescia - Intensive Care and Emergency; University of Brescia - Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health

More...

Abstract

Background: Post-traumatic cerebral infarction (PTCI) is common in patients dying after a traumatic brain injury (TBI). It is unclear what the occurrence of a PTCI is, how it impacts the long-term outcome, and whether it adds incremental prognostic value to established outcome predictors.

Methods: This was a prospective multicenter cohort study of moderate and severe TBI patients admitted to nine Italian intensive care units (ICUs). The primary objective was to evaluate if PTCI was an independent risk factor for the 6-month outcome assessed with the Glasgow Outcome Scale (GOS). We also assessed the PTCI occurrence and if it adds incremental value to the International Mission for Prognosis and Clinical Trial design in TBI (IMPACT) core and extended models.

Findings: We enrolled 143 patients; 47 (32·9%) developed a PTCI for a total of 94. The mean (SD) onset time of a PTCI was 6·2 (11·4). In the multiple ordered logistic regression, PTCI was retained in both the core and extended IMPACT models as an independent predictor of the GOS. The predictive performances increased significantly when PTCI was added to the IMPACT core model (AUC=0·73, 95% C.I. 0·66-0·82; increased to AUC=0·79, 95% CI 0·71-0·83, p=0·0007) and extended model (AUC=0·74, 95% C.I.: 0·65-0·81 increased to AUC=0·80, 95% C.I. 0·69-0·85; p=0·00008). Patients with a PTCI showed higher ICU mortality (10 patients [21·3%] vs one patient [1·0%], p<0·0001) and 6-month mortality (13 patients [27·7%] vs seven patients [7·3%], p<0·0001); whereas, hospital mortality did not differ between the two groups.

Interpretation: A PTCI is a common complication in patients suffering a moderate or severe TBI and is an independent risk factor for long-term disability. The addition of PTCI to the IMPACT core and extended predictive models significantly increased their performance in predicting the GOS.

Trial Registration Number: This study was registered with ClinicalTrials.gov (number NCT02430324).

Funding Statement: The present study was self-funded. The authors declare "none" to funding.

Declaration of Interests: The authors declare no competing interests.

Ethics Approval Statement: The study was conducted in accordance with the Declaration of Helsinki and was approved by the local Ethics Committees of each participating center. Patients’ informed consent was waived due to the lack of definition of a legal representative of temporarily incapacitated adult patients in the Italian legislation.11 The informed consent was obtained from the surviving patients as soon as they regained their mental competency. Family members received detailed information on the study scope and protocol. We followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for reporting cohort studies.

Suggested Citation

Fagoni, Nazzareno and Piva, Simone and Pinelli, Lorenzo and Frigerio, Michele and Tintori, Davide and Berardino, Maurizio and Bottazzi, Andrea and Carnevale, Livio and Casalicchio, Tiziana and Castioni, Carlo Alberto and Cavallo, Simona and Cerasti, Davide and Citerio, Giuseppe and Fontanella, Marco and Galiberti, Serena and Girardini, Alan and Gritti, Paolo and Manara, Ornella and Maremmani, Paolo and Mazzani, Roberta and Natalini, Giuseppe and Patassini, Mirko and Perna, Maria Elena and Pesaresi, Ilaria and Radolovich, Danila Katia and Saini, Maurizio and Stefini, Roberto and Minelli, Cosetta and Gasparotti, Roberto and Rasulo, Francesco A. and Latronico, Nicola, Impact of a Posttraumatic Cerebral Infarction on the Long-Term Outcome of Patients with Moderate and Severe Traumatic Brain Injuries: The Italian Multicenter Cohort INCEPT Study (January 16, 2019). Available at SSRN: https://ssrn.com/abstract=3320196

Nazzareno Fagoni

University of Brescia

Piazza del Mercato, 15
25122 Brescia
Italy

Simone Piva

ASST-Spedali Civili of Brescia

Via Nikolajewka, 13
25133 Brescia
Italy

Lorenzo Pinelli

ASST-Spedali Civili of Brescia

Via Nikolajewka, 13
25133 Brescia
Italy

Michele Frigerio

ASST-Spedali Civili of Brescia

Via Nikolajewka, 13
25133 Brescia
Italy

Davide Tintori

ASST-Spedali Civili of Brescia

Via Nikolajewka, 13
25133 Brescia
Italy

Maurizio Berardino

Città Della Salute e della Scienza

Turin
Italy

Andrea Bottazzi

Fondazione IRCCS Policlinico San Matteo

Pavia
Italy

Livio Carnevale

Fondazione IRCCS Policlinico San Matteo

Pavia
Italy

Tiziana Casalicchio

Ospedale San Giovanni Bosco

Piazza del Donatore di Sangue
Torino
Italy

Carlo Alberto Castioni

Ospedale San Giovanni Bosco

Piazza del Donatore di Sangue
Torino
Italy

Simona Cavallo

Azienda Ospedaliero-Universitaria

Turin
Italy

Davide Cerasti

University of Parma

Via Amendola 10
Parma, 43100
Italy

Giuseppe Citerio

University of Milan - Bicocca

Via Bicocca degli Arcimboldi, 8
Milano, Milano 20126
Italy

Marco Fontanella

University of Brescia

Piazza del Mercato, 15
25122 Brescia
Italy

Serena Galiberti

Azienda Ospedaliera-Universitaria Pisana

Pisa
Italy

Alan Girardini

Fondazione Poliambulanza

Italy

Paolo Gritti

Papa Giovanni XXIII Hospital

Bergamo
Italy

Ornella Manara

Papa Giovanni XXIII Hospital

Bergamo
Italy

Paolo Maremmani

Azienda Ospedaliera-Universitaria Pisana

Pisa
Italy

Roberta Mazzani

Azienda Ospedaliera Universitaria Maggiore della Carità

Novara
Italy

Giuseppe Natalini

Fondazione Poliambulanza

Italy

Mirko Patassini

ASST - Monza

Monza
Italy

Maria Elena Perna

Ospedale San Giovanni Bosco

Piazza del Donatore di Sangue
Torino
Italy

Ilaria Pesaresi

Azienda Ospedaliera-Universitaria Pisana

Pisa
Italy

Danila Katia Radolovich

Fondazione IRCCS Policlinico San Matteo

Pavia
Italy

Maurizio Saini

ASST - Monza

Monza
Italy

Roberto Stefini

Legnano Hospital

Milan
Italy

Cosetta Minelli

Imperial College London - National Heart and Lung Institute

Guy Scadding Building, Cale Street
London, SW3 6LY
United Kingdom

Roberto Gasparotti

ASST-Spedali Civili of Brescia

Via Nikolajewka, 13
25133 Brescia
Italy

Francesco A. Rasulo

ASST-Spedali Civili of Brescia

Via Nikolajewka, 13
25133 Brescia
Italy

Nicola Latronico (Contact Author)

ASST-Spedali Civili of Brescia - Intensive Care and Emergency ( email )

Italy

University of Brescia - Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health ( email )

Piazza del Mercato
Brescia
Italy

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