title: Is Impaired Autoregulation Associated with Mortality in Patients with Severe Cerebral Diseases?
abstract: Cerebral autoregulation (CA) is a mechanism that compensates for variations in cerebral perfusion pressure (CPP) by changes in cerebral blood flow resistance to keep the cerebral blood flow constant. In this study, the relationship between lethal outcome during hospitalisation and the autoregulation-related indices PRx and Mx was investigated.
  
  
  
  Thirty patients (aged 18-77 years, mean 53 ± 16 years) with severe cerebral diseases were studied. Cerebral blood flow velocity (CBFV), arterial blood pressure (ABP) and intracranial pressure (ICP) were repeatedly recorded. CA indices were calculated as the averaged correlation between CBFV and CPP (Mx) and between ABP and ICP (PRx). Positive index values indicated impairment of CA.
  
  
  
  Six patients died in hospital. In this group both PRx and Mx were significantly higher than in the group of survivors (PRx: 0.41 ± 0.33 vs 0.09 ± 0.25; Mx: 0.28 ± 0.40 vs 0.03 ± 0.21; p = 0.01 and 0.04, respectively). PRx and Mx correlated significantly with Glasgow Outcome Scale (GOS) score (PRx: R = -0.40, p < 0.05; Mx: R = -0.54, p < 0.005). PRx was the only significant risk factor for mortality (p < 0.05, logistic regression).
  
  
  
  Increased PRx and Mx were associated with risk of death in patients with severe cerebral diseases. The relationship with mortality was more pronounced in PRx, whereas Mx showed a better correlation with GOS score.
authors.affiliation: Department of Neurology, Chemnitz Medical Center, Dresdner Strasse 178, Chemnitz, 09131, Germany. B.Schmidt@skc.de.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schmidt
authors.affiliation: Department of Neurology, Chemnitz Medical Center, Dresdner Strasse 178, Chemnitz, 09131, Germany.
authors.forename: Vesna
authors.initials: V
authors.lastname: Lezaic
authors.affiliation: Department of Neurology, Chemnitz Medical Center, Dresdner Strasse 178, Chemnitz, 09131, Germany.
authors.forename: Marco
authors.initials: M
authors.lastname: Weinhold
authors.affiliation: Department of Neurology, Chemnitz Medical Center, Dresdner Strasse 178, Chemnitz, 09131, Germany.
authors.forename: Ronny
authors.initials: R
authors.lastname: Plontke
authors.affiliation: Department of Neurology, Chemnitz Medical Center, Dresdner Strasse 178, Chemnitz, 09131, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Schwarze
authors.affiliation: Department of Neurology, Chemnitz Medical Center, Dresdner Strasse 178, Chemnitz, 09131, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Klingelhöfer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001927:Brain Diseases / Q000401:mortality / Q000503:physiopathology*; D000070642:Brain Injuries, Traumatic / Q000401:mortality / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000401:mortality / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D004660:Encephalitis / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006706:Homeostasis; D006801:Humans; D002534:Hypoxia, Brain / Q000401:mortality / Q000503:physiopathology; D020244:Infarction, Middle Cerebral Artery / Q000401:mortality / Q000503:physiopathology; D020300:Intracranial Hemorrhages / Q000401:mortality / Q000503:physiopathology; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D008991:Monitoring, Physiologic; D011379:Prognosis; D012189:Retrospective Studies; D012851:Sinus Thrombosis, Intracranial / Q000401:mortality / Q000503:physiopathology; D013345:Subarachnoid Hemorrhage / Q000401:mortality / Q000503:physiopathology; D020206:Subarachnoid Hemorrhage, Traumatic / Q000401:mortality / Q000503:physiopathology; D017585:Ultrasonography, Doppler, Transcranial; D055815:Young Adult
keywords: Arterial blood pressure; Cerebral autoregulation; Cerebral blood flow velocity; Cerebrovascular reactivity; Glasgow Outcome Scale; Intracranial pressure