Abstract
Hypothermia has been used in postoperative management of traumatic brain injury (TBI); however, the rhythmic variation and prognostic value of brain temperature after TBI have never been studied. This study describes diurnal brain temperature patterns in comatose patients with TBI. Mesors of brain temperature, amplitude, and acrophase were estimated from recorded temperature measurements using cosinor analysis. The association of these patterns with clinical parameters, mortality, and functional outcomes in a 12-month follow-up was examined. According to the cosinor analysis, 59.3% of patients presented with circadian rhythms of brain temperature in the first 72 h postoperatively. The rhythm-adjusted mesor of brain temperature was 37.39 ± 1.21 °C, with a diminished mean amplitude of 0.28 (±0.25) °C; a shift of temperature acrophase was also observed. Multivariate logistic regression analysis revealed that initial Glasgow coma scale score, age, elevated blood glucose level, and circadian rhythm of brain temperature seemed to be predictive and prognostic factors of patients’ functional outcomes. For the prediction of survival status, younger patients or those patients with mesor within the middle 50% of brain temperature were more likely to survive. The analysis of brain temperature rhythms in patients with moderate and severe TBI provided additional predictive information related to mortality and functional outcomes.
Highlights
Improvements in diagnosis, surgical intervention, and intensive care have allowed many patients to survive traumatic brain injury (TBI); the long-lasting disability has led to significant functional, emotional, and economic sequelae [1,2]
Our study provides a comprehensive characterization and analysis of brain temperature rhythm in patients who underwent surgery for moderate to severe TBI and examined the association of brain temperature rhythm with mortality and 12-month functional outcomes
The results of the multivariate analysis demonstrated that age, initial Glasgow coma scale (GCS) score, blood glucose level, and the presence of brain temperature rhythm were significantly correlated with the functional outcome 12 months after surgery, while age and mesor of brain temperature were associated with patient survival
Summary
Improvements in diagnosis, surgical intervention, and intensive care have allowed many patients to survive traumatic brain injury (TBI); the long-lasting disability has led to significant functional, emotional, and economic sequelae [1,2]. Previous studies have identified clinical parameters to predict conscious and functional recovery, including Glasgow coma scale (GCS) score, age, electroencephalogram (EEG) results, image findings, pupillary response to light, and somatosensory evoked potential (SSEP) [1,3,4,5]. Age and GCS score were consistently recognized as useful outcome predictors in several studies. EEG has been widely used to evaluate comatose patients; its application as a predictor in traumatic coma was not as sensitive as in hypoxic-ischemic coma [6]. Outcomes of patients with TBI are still often unpredictable during the early stage of treatment
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