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001-es BibID:	BIBFORM107420
035-os BibID:	(scopus)85122939948 (wos)000769111800016
Első szerző:	Galimberti, Stefania
Cím:	Effect of frailty on 6-month outcome after traumatic brain injury : a multicentre cohort study with external validation / Galimberti Stefania, Graziano Francesca, Maas Andrew I. R., Isernia Giulia, Lecky Fiona, Jain Sonia, Sun Xiaoying, Gardner Raquel C., Taylor Sabrina R., Markowitz Amy J., Manley Geoffrey T., Valsecchi Maria Grazia, Bellelli Giuseppe, Citerio Giuseppe, CENTER-TBI participants and investigators, TRACK-TBI participants and investigators
Dátum:	2022
ISSN:	1474-4422 1474-4465
Megjegyzések:	Summary Background Frailty is known to be associated with poorer outcomes in individuals admitted to hospital for medical conditions requiring intensive care. However, little evidence is available for the effect of frailty on patients' outcomes after traumatic brain injury. Many frailty indices have been validated for clinical practice and show good performance to predict clinical outcomes. However, each is specific to a particular clinical context. We aimed to develop a frailty index to predict 6-month outcomes in patients after a traumatic brain injury. Methods A cumulative deficit approach was used to create a novel frailty index based on 30 items dealing with disease states, current medications, and laboratory values derived from data available from CENTER-TBI, a prospective, longitudinal observational study of patients with traumatic brain injury presenting within 24 h of injury and admitted to a ward or an intensive care unit at 65 centres in Europe between Dec 19, 2014, and Dec 17, 2017. From the individual cumulative CENTER-TBI frailty index (range 0?30), we obtained a standardised value (range 0?1), with high scores indicating higher levels of frailty. The effect of frailty on 6-month outcome evaluated with the extended Glasgow Outcome Scale (GOSE) was assessed through a proportional odds logistic model adjusted for known outcome predictors. An unfavourable outcome was defined as death or severe disability (GOSE score ?4). External validation was performed on data from TRACK-TBI, a prospective observational study co-designed with CENTER-TBI, which enrolled patients with traumatic brain injury at 18 level I trauma centres in the USA from Feb 26, 2014, to July 27, 2018. CENTER-TBI is registered with ClinicalTrials.gov, NCT02210221; TRACK-TBI is registered at ClinicalTrials.gov, NCT02119182. Findings 2993 participants (median age was 51 years [IQR 30?67], 2058 [69%] were men) were included in this analysis. The overall median CENTER-TBI frailty index score was 0?07 (IQR 0?03?0?15), with a median score of 0?17 (0?08?0?27) in older adults (aged ?65 years). The CENTER-TBI frailty index score was significantly associated with the probability of an increasingly unfavourable outcome (cumulative odds ratio [OR] 1?03, 95% CI 1?02?1?04; p<0?0001), and the association was stronger for participants admitted to hospital wards (1? 04, 1?03?1?06, p<0?0001) compared with those admitted to the intensive care unit (1 ?02, 1?01?1?03 p<0?0001). External validation of the CENTER-TBI frailty index in data from the TRACK-TBI (n=1667) cohort supported the robustness and reliability of these findings. The overall median TRACK-TBI frailty index score was 0?03 (IQR 0?0?10), with the frailty index score significantly associated with the risk of an increasingly unfavourable outcome in patients admitted to hospital wards (cumulative OR 1?05, 95% CI 1?03?1?08; p<0?0001), but not in those admitted to the intensive care unit (1?01, 0?99?1?03; p=0?43)
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban folyóiratcikk traumatic brain injury
Megjelenés:	Lancet Neurology. - 21 : 2 (2022), p. 153-162. -
További szerzők:	Graziano, Francesca Maas, Andrew I. R. Isernia, Giulia Lecky, Fiona Jain, Sonia Sun, Xiaoying Gardner, Raquel C. Taylor, Sabrina R. Markowitz, Amy J. Manley, Geoffrey T. Valsecchi, Maria Grazia Bellelli, Giuseppe Citerio, Giuseppe Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators TRACK-TBI Investigators
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