The following is a summary of “Impact of age and mean intracranial pressure on the morphology of intracranial pressure waveform and its association with mortality in traumatic brain injury,” published in the February 2025 issue of Critical Care by Kasprowicz et al.
Morphological analysis of intracranial pressure (ICP) pulse waveforms offers indirect insights into cerebrospinal compliance, which can be affected by factors like space-occupying lesions, intracranial hypertension, and aging.
Researchers conducted a retrospective study to examine the effects of age and mean ICP on the shape and amplitude of ICP pulse waveforms in traumatic brain injury (TBI) and association with mortality.
They analyzed ICP recordings from 183 patients with TBI (median age: 50 [30, 61] years) from the CENTER-TBI database, the ICP morphology was investigated using the artificial intelligence-based pulse shape index (PSI) and peak-to-peak amplitude of ICP pulse waveform (AmpICP). Factorial ANOVA was used to estimate the impact of mean ICP, age, and interaction on PSI and AmpICP. To adjust for intracranial volume disturbances, multiple regression analysis with age, mean ICP, and the Rotterdam Computed tomography (CT) score as variables was performed. The relationship between AmpICP, PSI, and 6-month mortality was estimated using the area under the Receiver operating characteristic (ROC) curve (AUC).
The results showed that age significantly influenced PSI (P < 0.01), explaining 33.1% of its variance, while mean ICP accounted for 6.6% (P < 0.01). In contrast, mean ICP mainly affected AmpICP (P < 0.01), explaining 22.8% of its variance, with age contributing 8.0% (P < 0.01). The combined effect of age and mean ICP explained 11.7% of AmpICP variance (P = 0.01), but did not affect PSI. After adjusting for Rotterdam CT score, age remained the strongest factor influencing PSI (β = 0.342, P < 0.01), while elevated mean ICP had a dominant effect on AmpICP (β = 0.522, P < 0.01). Both AmpICP and PSI showed moderate association with 6-month mortality (AUC: 0.76 and 0.71, respectively).
Investigators concluded that AmpICP and PSI, reflecting distinct aspects of cerebrospinal compliance, were associated with mortality after TBI, with aging contributing to increased susceptibility to elevated intracranial pressure.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-025-05295-w
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