Is age or cardiovascular comorbidity the main predictor of reduced cerebrovascular pressure reactivity in older patients with traumatic brain injury?
Introduction: The Pressure Reactivity index (PRx) has been proposed as a surrogate measure for cerebrovascular autoregulation (CA) and it has been described that older age is associated with worse PRx. The etiology for this reduced capacity remains unknown. Research question: To investigate the rela...
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Elsevier
2024-01-01
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| Series: | Brain and Spine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772529424000559 |
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| author | Floor Vanelderen Dominike Bruyninckx Bart Depreitere |
| author_facet | Floor Vanelderen Dominike Bruyninckx Bart Depreitere |
| author_sort | Floor Vanelderen |
| collection | DOAJ |
| description | Introduction: The Pressure Reactivity index (PRx) has been proposed as a surrogate measure for cerebrovascular autoregulation (CA) and it has been described that older age is associated with worse PRx. The etiology for this reduced capacity remains unknown. Research question: To investigate the relation between age and PRx in a cohort of patients with traumatic brain injury (TBI) while correcting for cardiovascular comorbidities. Material and methods: This is a retrospective analysis on prospectively collected data in 151 consecutive TBI patients between 2013 and 2023. PRx was averaged over 5 monitoring days and correlated with demographic, patient and injury data. A multiple regression analysis was performed with PRx as dependent variable and cardiovascular comorbidities, age, Glasgow motor score and pupillary reaction as independent variables. A similar model was constructed without age and compared. Results: Age, sex, thromboembolic history, arterial hypertension, Glasgow motor score and pupillary reaction significantly correlated with PRx in univariate analysis. In multivariate analysis, age had a significant worsening effect on PRx (p = 0.01), while the cardiovascular risk factors and injury severity had no impact. The comparison of the models with and without age yielded a significant difference (p = 0.01), underpinning the independent effect of age. Discussion and conclusion: In the present cohort study in TBI patients it was found that older age independently impaired cerebrovascular pressure reactivity regardless of cardiovascular comorbidity. Pathophysiology of TBI and physiology of ageing seem to line up to synergistically produce a negative effect on brain perfusion. |
| format | Article |
| id | doaj-art-29e7aa480b90407988c3dc5ec7222b2a |
| institution | Kabale University |
| issn | 2772-5294 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain and Spine |
| spelling | doaj-art-29e7aa480b90407988c3dc5ec7222b2a2024-12-15T06:18:20ZengElsevierBrain and Spine2772-52942024-01-014102799Is age or cardiovascular comorbidity the main predictor of reduced cerebrovascular pressure reactivity in older patients with traumatic brain injury?Floor Vanelderen0Dominike Bruyninckx1Bart Depreitere2Neurosurgery, University Hospitals Leuven, Leuven, BelgiumNeurosurgery, University Hospitals Leuven, Leuven, BelgiumCorresponding author. Neurosurgery, University Hospitals Leuven, Herestraat 49, Leuven, B-3000, Belgium.; Neurosurgery, University Hospitals Leuven, Leuven, BelgiumIntroduction: The Pressure Reactivity index (PRx) has been proposed as a surrogate measure for cerebrovascular autoregulation (CA) and it has been described that older age is associated with worse PRx. The etiology for this reduced capacity remains unknown. Research question: To investigate the relation between age and PRx in a cohort of patients with traumatic brain injury (TBI) while correcting for cardiovascular comorbidities. Material and methods: This is a retrospective analysis on prospectively collected data in 151 consecutive TBI patients between 2013 and 2023. PRx was averaged over 5 monitoring days and correlated with demographic, patient and injury data. A multiple regression analysis was performed with PRx as dependent variable and cardiovascular comorbidities, age, Glasgow motor score and pupillary reaction as independent variables. A similar model was constructed without age and compared. Results: Age, sex, thromboembolic history, arterial hypertension, Glasgow motor score and pupillary reaction significantly correlated with PRx in univariate analysis. In multivariate analysis, age had a significant worsening effect on PRx (p = 0.01), while the cardiovascular risk factors and injury severity had no impact. The comparison of the models with and without age yielded a significant difference (p = 0.01), underpinning the independent effect of age. Discussion and conclusion: In the present cohort study in TBI patients it was found that older age independently impaired cerebrovascular pressure reactivity regardless of cardiovascular comorbidity. Pathophysiology of TBI and physiology of ageing seem to line up to synergistically produce a negative effect on brain perfusion.http://www.sciencedirect.com/science/article/pii/S2772529424000559Traumatic brain injuryAgeCerebrovascular pressure reactivityCerebrovascular autoregulation |
| spellingShingle | Floor Vanelderen Dominike Bruyninckx Bart Depreitere Is age or cardiovascular comorbidity the main predictor of reduced cerebrovascular pressure reactivity in older patients with traumatic brain injury? Brain and Spine Traumatic brain injury Age Cerebrovascular pressure reactivity Cerebrovascular autoregulation |
| title | Is age or cardiovascular comorbidity the main predictor of reduced cerebrovascular pressure reactivity in older patients with traumatic brain injury? |
| title_full | Is age or cardiovascular comorbidity the main predictor of reduced cerebrovascular pressure reactivity in older patients with traumatic brain injury? |
| title_fullStr | Is age or cardiovascular comorbidity the main predictor of reduced cerebrovascular pressure reactivity in older patients with traumatic brain injury? |
| title_full_unstemmed | Is age or cardiovascular comorbidity the main predictor of reduced cerebrovascular pressure reactivity in older patients with traumatic brain injury? |
| title_short | Is age or cardiovascular comorbidity the main predictor of reduced cerebrovascular pressure reactivity in older patients with traumatic brain injury? |
| title_sort | is age or cardiovascular comorbidity the main predictor of reduced cerebrovascular pressure reactivity in older patients with traumatic brain injury |
| topic | Traumatic brain injury Age Cerebrovascular pressure reactivity Cerebrovascular autoregulation |
| url | http://www.sciencedirect.com/science/article/pii/S2772529424000559 |
| work_keys_str_mv | AT floorvanelderen isageorcardiovascularcomorbiditythemainpredictorofreducedcerebrovascularpressurereactivityinolderpatientswithtraumaticbraininjury AT dominikebruyninckx isageorcardiovascularcomorbiditythemainpredictorofreducedcerebrovascularpressurereactivityinolderpatientswithtraumaticbraininjury AT bartdepreitere isageorcardiovascularcomorbiditythemainpredictorofreducedcerebrovascularpressurereactivityinolderpatientswithtraumaticbraininjury |