Clustering identifies endotypes of traumatic brain injury in an intensive care cohort: a CENTER-TBI study
dc.date.accessioned | 2023-03-17T17:27:11Z | |
dc.date.available | 2023-03-17T17:27:11Z | |
dc.date.created | 2023-01-31T18:00:43Z | |
dc.date.issued | 2022 | |
dc.identifier.citation | Åkerlund, Cecilia Holst, Anders Stocchetti, Nino Steyerberg, Ewout W Menon, David K Ercole, Ari Vik, Anne Skandsen, Toril Røise, Olav Kolias, Angelos G Helseth, Eirik Andelic, Nada Andreassen, Lasse Anke, Audny Gabriele Wagner Røe, Cecilie Amrein, Krisztina Antoni, Anna Audibert, Gérard Azouvi, Philippe Azzolini, Maria Luisa Bartels, Ronald Barzó, Pál Beauvais, Romuald Beer, Ronny Bellander, Bo-Michael Belli, Antonio Benali, Habib Berardino, Maurizio Beretta, Luigi Blaabjerg, Morten Bragge, Peter Brazinova, Alexandra Brinck, Vibeke Brooker, Joanne Brorsson, Camilla Buki, Andras Bullinger, Monika Cabeleira, Manuel Caccioppola, Alessio Calappi, Emiliana Calvi, Maria Rosa Cameron, Peter Lozano, Guillermo Carbayo Carbonara, Marco Cavallo, Simona Chevallard, Giorgio Chieregato, Arturo Citerio, Giuseppe Clusmann, Hans Coburn, Mark . Clustering identifies endotypes of traumatic brain injury in an intensive care cohort: a CENTER-TBI study. Critical Care. 2022, 26 | |
dc.identifier.uri | http://hdl.handle.net/10852/101575 | |
dc.description.abstract | Background While the Glasgow coma scale (GCS) is one of the strongest outcome predictors, the current classification of traumatic brain injury (TBI) as ‘mild’, ‘moderate’ or ‘severe’ based on this fails to capture enormous heterogeneity in pathophysiology and treatment response. We hypothesized that data-driven characterization of TBI could identify distinct endotypes and give mechanistic insights. Methods We developed an unsupervised statistical clustering model based on a mixture of probabilistic graphs for presentation (< 24 h) demographic, clinical, physiological, laboratory and imaging data to identify subgroups of TBI patients admitted to the intensive care unit in the CENTER-TBI dataset (N = 1,728). A cluster similarity index was used for robust determination of optimal cluster number. Mutual information was used to quantify feature importance and for cluster interpretation. Results Six stable endotypes were identified with distinct GCS and composite systemic metabolic stress profiles, distinguished by GCS, blood lactate, oxygen saturation, serum creatinine, glucose, base excess, pH, arterial partial pressure of carbon dioxide, and body temperature. Notably, a cluster with ‘moderate’ TBI (by traditional classification) and deranged metabolic profile, had a worse outcome than a cluster with ‘severe’ GCS and a normal metabolic profile. Addition of cluster labels significantly improved the prognostic precision of the IMPACT (International Mission for Prognosis and Analysis of Clinical trials in TBI) extended model, for prediction of both unfavourable outcome and mortality (both p < 0.001). Conclusions Six stable and clinically distinct TBI endotypes were identified by probabilistic unsupervised clustering. In addition to presenting neurology, a profile of biochemical derangement was found to be an important distinguishing feature that was both biologically plausible and associated with outcome. Our work motivates refining current TBI classifications with factors describing metabolic stress. Such data-driven clusters suggest TBI endotypes that merit investigation to identify bespoke treatment strategies to improve care. | |
dc.language | EN | |
dc.rights | Attribution 4.0 International | |
dc.rights.uri | https://creativecommons.org/licenses/by/4.0/ | |
dc.title | Clustering identifies endotypes of traumatic brain injury in an intensive care cohort: a CENTER-TBI study | |
dc.title.alternative | ENEngelskEnglishClustering identifies endotypes of traumatic brain injury in an intensive care cohort: a CENTER-TBI study | |
dc.type | Journal article | |
dc.creator.author | Åkerlund, Cecilia | |
dc.creator.author | Holst, Anders | |
dc.creator.author | Stocchetti, Nino | |
dc.creator.author | Steyerberg, Ewout W | |
dc.creator.author | Menon, David K | |
dc.creator.author | Ercole, Ari | |
dc.creator.author | Vik, Anne | |
dc.creator.author | Skandsen, Toril | |
dc.creator.author | Røise, Olav | |
dc.creator.author | Kolias, Angelos G | |
dc.creator.author | Helseth, Eirik | |
dc.creator.author | Andelic, Nada | |
dc.creator.author | Andreassen, Lasse | |
dc.creator.author | Anke, Audny Gabriele Wagner | |
dc.creator.author | Røe, Cecilie | |
dc.creator.author | Amrein, Krisztina | |
dc.creator.author | Antoni, Anna | |
dc.creator.author | Audibert, Gérard | |
dc.creator.author | Azouvi, Philippe | |
dc.creator.author | Azzolini, Maria Luisa | |
dc.creator.author | Bartels, Ronald | |
dc.creator.author | Barzó, Pál | |
dc.creator.author | Beauvais, Romuald | |
dc.creator.author | Beer, Ronny | |
dc.creator.author | Bellander, Bo-Michael | |
dc.creator.author | Belli, Antonio | |
dc.creator.author | Benali, Habib | |
dc.creator.author | Berardino, Maurizio | |
dc.creator.author | Beretta, Luigi | |
dc.creator.author | Blaabjerg, Morten | |
dc.creator.author | Bragge, Peter | |
dc.creator.author | Brazinova, Alexandra | |
dc.creator.author | Brinck, Vibeke | |
dc.creator.author | Brooker, Joanne | |
dc.creator.author | Brorsson, Camilla | |
dc.creator.author | Buki, Andras | |
dc.creator.author | Bullinger, Monika | |
dc.creator.author | Cabeleira, Manuel | |
dc.creator.author | Caccioppola, Alessio | |
dc.creator.author | Calappi, Emiliana | |
dc.creator.author | Calvi, Maria Rosa | |
dc.creator.author | Cameron, Peter | |
dc.creator.author | Lozano, Guillermo Carbayo | |
dc.creator.author | Carbonara, Marco | |
dc.creator.author | Cavallo, Simona | |
dc.creator.author | Chevallard, Giorgio | |
dc.creator.author | Chieregato, Arturo | |
dc.creator.author | Citerio, Giuseppe | |
dc.creator.author | Clusmann, Hans | |
dc.creator.author | Coburn, Mark | |
cristin.unitcode | 185,53,44,0 | |
cristin.unitname | Ortopedisk klinikk | |
cristin.ispublished | true | |
cristin.fulltext | original | |
cristin.fulltext | original | |
cristin.qualitycode | 2 | |
dc.identifier.cristin | 2120836 | |
dc.identifier.bibliographiccitation | info:ofi/fmt:kev:mtx:ctx&ctx_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.jtitle=Critical Care&rft.volume=26&rft.spage=&rft.date=2022 | |
dc.identifier.jtitle | Critical Care | |
dc.identifier.volume | 26 | |
dc.identifier.issue | 1 | |
dc.identifier.pagecount | 15 | |
dc.identifier.doi | https://doi.org/10.1186/s13054-022-04079-w | |
dc.type.document | Tidsskriftartikkel | |
dc.type.peerreviewed | Peer reviewed | |
dc.source.issn | 1364-8535 | |
dc.type.version | PublishedVersion | |
cristin.articleid | 228 |
Files in this item
Appears in the following Collection
-
Institutt for klinisk medisin [10814]
-
CRIStin høstingsarkiv [31446]