Predictive value of blood pressure variability for the prognosis of decompressive craniectomy in patients with severe traumatic brain injury
Hong Zaofeng
Wang Popo
Abstract：Objective To investigate the predictive value of blood pressure variability for the prognosis of decompressive craniectomy in patients with severe traumatic brain injury(sTBI).Methods Clinical data of 86 sTBI patients who underwent decompressive craniectomy,were analyzed retrospectively.Prognosis was assessed using the Glasgow Outcome Scale(GOS)at 3 months postoperatively,and patients were divided into a poor prognosis group(n=42,GOS≤3 points)and a good prognosis group(n=44,GOS≥4 points)based on GOS scores.Differences in clinical data between the two groups were compared.The LASSO-logistic regression model and the receiver operating characteristic(ROC)curve were used to analyze the impact of blood pressure variability,including the standard deviation(SD)and coefficient of blood pressure variation(CV)of systolic pressure(SBP)and diastolic pressure(DBP)at admission and 24 and 72 h post-admission,on the prognosis of sTBI patients.Results The poor prognosis group had higher intracranial hematoma volume,preoperative intracranial pressure,and proportion of patients with preoperative midline shift≥10 mm compared to the good prognosis group,while the preoperative Glasgow Coma Scale(GCS)score was lower in the poor prognosis group(all P<0.05).The SD of SBP(SDSBP),SD of DBP(SDDBP),CV of SBP(CVSBP),and CV of DBP(CVDBP)at 24 and 72 h post-admission were all higher in the poor prognosis group than in the good prognosis group(all P<0.05).LASSO screening identified four non-zero coefficients(intracranial pressure,intracranial hematoma volume,72-h SDSBP,and 72-h CVSBP).Further multivariate logistic regression analysis showed that intracranial pressure(OR=1.161,95%CI:1.043-1.293),72-h SDSBP(OR=1.344,95%CI:1.073-1.683),and 72-h CVSBP(OR=6.031,95%CI:2.332-15.601)were risk factors for poor prognosis after decompressive craniectomy in sTBI patients(all P<0.05).The ROC curve indicated that the area under the curve(AUC)for predicting poor prognosis in sTBI patients was 0.801(95%CI:0.711-0.892)for 72-h SDSBP and 0.810(95%CI:0.719-0.901)for 72-h CVSBP.Conclusions The 72-h SDSBP and CVSBP are key predictors of poor prognosis after decompressive craniectomy in sTBI patients and demonstrate good predictive efficacy for patient prognosis.
Keywords：brain injuriestraumaticsevereblood pressure variabilitydecompressive craniectomyprognosis
Publication Date：2025-07-20
Online Publishing Date：2025-08-21(First online date of this platform, not the publication date of the document)
Pages：5( 428-432 )