Abstract

Importance

Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Hypotension in patients with TBI is associated with poorer outcomes. A comprehensive review examining adverse outcomes of hypotension in patients with TBI is needed.

Objective

To investigate the mortality and incidence of hypotension in patients with TBI.

Data Sources

A search of studies published before April 2024 was conducted using MEDLINE, MEDLINE In Process, ePubs, Embase, Classic+Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews for primary research articles in English, including randomized control trials, quasirandomized studies, prospective cohorts, retrospective studies, longitudinal studies, and cross-sectional surveys.

Study Selection

Inclusion criteria were patients aged at least 10 years with moderate to severe TBI with hypotension. The exclusion criteria were mild TBI (due to the differences in management principles from moderate to severe TBI). Data were screened using Covidence software with multiple reviewers.

Data Extraction and Synthesis

This meta-analysis conforms to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines for assessing data quality and validity. Primary outcomes (unadjusted and adjusted odds ratios [ORs]) were calculated using a random-effect model with 95% CIs. Incidence of hypotension was derived using logit transformation.

Main Outcomes and Measures

Main outcomes were association of hypotension with death and/or vegetative state within 6 months and incidence of hypotension. Vegetative state was not reported due to lack of data from included studies. Hypothesis testing occurred before data collection.

Results

The search strategy identified 17 676 unique articles. The final review included 51 studies (384 329 patients). Pooled analysis of found a significant increase in mortality in patients with hypotension and moderate to severe TBI (crude OR, 3.82; 95% CI, 3.04-4.81; P < .001; I2 = 96.98%; adjusted OR, 2.22; 95% CI, 1.96-2.51; P < .001; I2 = 92.21%). The overall hypotension incidence was 18% (95% CI, 12%-26%) (P < .001; I2 = 99.84%).

Conclusions and Relevance

This meta-analysis of nearly 400 000 patients with TBI found a significant association of greater than 2-fold odds of mortality in patients with hypotension and TBI. This comprehensive analysis can guide future management recommendations, specifically with respect to blood pressure threshold management to reduce deaths when treating patients with TBI.

Key Points

Question Is hypotension associated with adverse outcomes in patients with moderate to severe traumatic brain injury (TBI)?

Findings This systematic review and meta-analysis of 51 studies and 384 329 patients found that patients with TBI and hypotension had significantly increased odds of mortality. Incidence of hypotension was 18%.

Meaning  These findings highlight the importance of blood pressure management in TBI settings.

요약

소개

외상성 뇌손상(TBI)은 전 세계적으로 주요 사망 및 장애의 원인이다. TBI 환자에서의 저혈압은 더 나쁜 임상 결과와 연관되어있다. 본 연구는 TBI 환자에서 저혈압의 사망률 및 발생률을 조사하고, 저혈압이 중등도에서 중증 외상성 뇌손상(TBI) 환자에게 부정적인 결과와 관련이 있는지 여부를 확인하는 것을 목표로 하는 메타분석 연구이다.

결과

51개의 연구와 384,329명의 환자가 포함된 리뷰 및 메타 분석에서, TBI와 저혈압을 가진 환자들이 사망률이 유의미하게 증가한 것으로 나타났다. 중등도에서 중증 TBI환자에서 저혈압 발생률은 18%였다.

결론 및 의의

이 메타 분석 연구는 약 40만 명의 TBI 환자에서 저혈압이 있을 경우 사망률이 2배 이상 높다는 중요한 연관성을 발견했다. 즉, 이 연구 결과는 TBI 치료에서 혈압 관리의 중요성을 강조하고 있다.

이러한 종합적인 분석은 향후 치료 가이드라인에 도움을 줄 수 있으며, 특히 TBI 환자를 치료할 때 사망을 줄이기 위한 혈압 기준 관리에 관한 중요한 정보를 제공한다.