• Erta Beqiri, Frederick A Zeiler, Ari Ercole, Michal M Placek, Jeanette Tas, Joseph Donnelly, AriesMarcel J HMJHSchool for Mental Health and Neuroscience (MHeNS), University Maastricht, Maastricht, The Netherlands.Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands., Peter J Hutchinson, David Menon, Nino Stocchetti, Marek Czosnyka, Peter Smielewski, and CENTER-TBI HR ICU participants and investigators.
• Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK. vb391@cam.ac.uk.
• Crit Care. 2023 May 20; 27 (1): 194194.

BackgroundA previous retrospective single-centre study suggested that the percentage of time spent with cerebral perfusion pressure (CPP) below the individual lower limit of reactivity (LLR) is associated with mortality in traumatic brain injury (TBI) patients. We aim to validate this in a large multicentre cohort.MethodsRecordings from 171 TBI patients from the high-resolution cohort of the CENTER-TBI study were processed with ICM+ software. We derived LLR as a time trend of CPP at a level for which the pressure reactivity index (PRx) indicates impaired cerebrovascular reactivity with low CPP. The relationship with mortality was assessed with Mann-U test (first 7-day period), Kruskal-Wallis (daily analysis for 7 days), univariate and multivariate logistic regression models. AUCs (CI 95%) were calculated and compared using DeLong's test.ResultsAverage LLR over the first 7 days was above 60 mmHg in 48% of patients. %time with CPP < LLR could predict mortality (AUC 0.73, p =  < 0.001). This association becomes significant starting from the third day post injury. The relationship was maintained when correcting for IMPACT covariates or for high ICP.ConclusionsUsing a multicentre cohort, we confirmed that CPP below LLR was associated with mortality during the first seven days post injury.© 2023. The Author(s).

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