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Koskinen, Lars-Owe D., ProfessorORCID iD iconorcid.org/0000-0003-3528-8502
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Björnfot, C., Eklund, A., Larsson, J., Hansson, W., Birnefeld, J., Garpebring, A., . . . Wåhlin, A. (2024). Cerebral arterial stiffness is linked to white matter hyperintensities and perivascular spaces in older adults: a 4D flow MRI study. Journal of Cerebral Blood Flow and Metabolism
Öppna denna publikation i ny flik eller fönster >>Cerebral arterial stiffness is linked to white matter hyperintensities and perivascular spaces in older adults: a 4D flow MRI study
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2024 (Engelska)Ingår i: Journal of Cerebral Blood Flow and Metabolism, ISSN 0271-678X, E-ISSN 1559-7016Artikel i tidskrift (Refereegranskat) Epub ahead of print
Abstract [en]

White matter hyperintensities (WMH), perivascular spaces (PVS) and lacunes are common MRI features of small vessel disease (SVD). However, no shared underlying pathological mechanism has been identified. We investigated whether SVD burden, in terms of WMH, PVS and lacune status, was related to changes in the cerebral arterial wall by applying global cerebral pulse wave velocity (gcPWV) measurements, a newly described marker of cerebral vascular stiffness. In a population-based cohort of 190 individuals, 66–85 years old, SVD features were estimated from T1-weighted and FLAIR images while gcPWV was estimated from 4D flow MRI data. Additionally, the gcPWV’s stability to variations in field-of-view was analyzed. The gcPWV was 10.82 (3.94) m/s and displayed a significant correlation to WMH and white matter PVS volume (r = 0.29, p < 0.001; r = 0.21, p = 0.004 respectively from nonparametric tests) that persisted after adjusting for age, blood pressure variables, body mass index, ApoB/A1 ratio, smoking as well as cerebral pulsatility index, a previously suggested early marker of SVD. The gcPWV displayed satisfactory stability to field-of-view variations. Our results suggest that SVD is accompanied by changes in the cerebral arterial wall that can be captured by considering the velocity of the pulse wave transmission through the cerebral arterial network.

Ort, förlag, år, upplaga, sidor
Sage Publications, 2024
Nyckelord
4D flow MRI, cerebral small vessel disease, perivascular spaces, pulse wave velocity, white matter hyperintensities
Nationell ämneskategori
Kardiologi Neurologi Radiologi och bildbehandling
Identifikatorer
urn:nbn:se:umu:diva-221120 (URN)10.1177/0271678X241230741 (DOI)001157963000001 ()38315044 (PubMedID)2-s2.0-85184419786 (Scopus ID)
Forskningsfinansiär
Stiftelsen för strategisk forskning (SSF), RMX18-0152Hjärt-Lungfonden, 20180513Hjärt-Lungfonden, 20210653Hjärnfonden, F2022-0216Vetenskapsrådet, 2017-04949Vetenskapsrådet, 2022-04263Region Västerbotten
Tillgänglig från: 2024-02-22 Skapad: 2024-02-22 Senast uppdaterad: 2024-02-22
Magnusson, B. M. & Koskinen, L.-O. D. (2024). Classification and characterization of traumatic brain injuries in the northern region of sweden. Journal of Clinical Medicine, 13(1), Article ID 8.
Öppna denna publikation i ny flik eller fönster >>Classification and characterization of traumatic brain injuries in the northern region of sweden
2024 (Engelska)Ingår i: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 13, nr 1, artikel-id 8Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Traumatic brain injury (TBI) is a common cause of death and disability, the incidence of which in northern Sweden is not fully investigated. This study classifies and characterize epidemiological and demographic features of TBIs in a defined population in Umeå county, Sweden. Specifically, to evaluate frequencies of (1) intracranial lesions detected with computed tomography (CT), (2) need for emergency intervention, and (3) hospital admission, in minimal, mild, moderate, and severe TBI, respectively.

Methods: The data were gathered from 4057 TBI patients visiting our emergency room (ER) during a two-year period (2015–2016), of whom 56% were men and approximately 95% had minimal TBIs (Glasgow Coma Scale (GCS), score 15).

Results: Of all injuries, 97.8% were mild (GCS 14–15), 1.7% were moderate (GCS 9–13), and 0.5% were severe (GCS < 9). CT scans were performed on 46% of the patients, with 28% being hospitalized. A high annual TBI incidence of 1350 cases per 100,000 citizens was found. The mortality rate was 0.5% with the majority as expected in the elderly group (>80 years).

Conclusions: Minimal TBIs were not as mild as previously reported, with a relatively high frequency of abnormal CT findings and a high mortality rate. No emergency intervention was required in patients in the GCS 13–15 group with normal CT scans. These findings have implications for clinical practice in the ER with the suggestion to include biomarkers to reduce unnecessary CT scans.

Ort, förlag, år, upplaga, sidor
MDPI, 2024
Nyckelord
admission, CT scan, demographics, epidemiological, Glasgow Coma Scale, intervention, outcome, prospective, traumatic brain injury
Nationell ämneskategori
Kirurgi Neurologi
Identifikatorer
urn:nbn:se:umu:diva-219752 (URN)10.3390/jcm13010008 (DOI)2-s2.0-85181877378 (Scopus ID)
Tillgänglig från: 2024-01-19 Skapad: 2024-01-19 Senast uppdaterad: 2024-01-19Bibliografiskt granskad
van Essen, T. A., van Erp, I. A., Lingsma, H. F., Pisică, D., Yue, J. K., Singh, R. D., . . . Peul, W. C. (2023). Comparative effectiveness of decompressive craniectomy versus craniotomy for traumatic acute subdural hematoma (CENTER-TBI): an observational cohort study. eClinicalMedicine, 63, Article ID 102161.
Öppna denna publikation i ny flik eller fönster >>Comparative effectiveness of decompressive craniectomy versus craniotomy for traumatic acute subdural hematoma (CENTER-TBI): an observational cohort study
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2023 (Engelska)Ingår i: eClinicalMedicine, E-ISSN 2589-5370, Vol. 63, artikel-id 102161Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND: Limited evidence existed on the comparative effectiveness of decompressive craniectomy (DC) versus craniotomy for evacuation of traumatic acute subdural hematoma (ASDH) until the recently published randomised clinical trial RESCUE-ASDH. In this study, that ran concurrently, we aimed to determine current practice patterns and compare outcomes of primary DC versus craniotomy.

METHODS: We conducted an analysis of centre treatment preference within the prospective, multicentre, observational Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (known as CENTER-TBI) and NeuroTraumatology Quality Registry (known as Net-QuRe) studies, which enrolled patients throughout Europe and Israel (2014-2020). We included patients with an ASDH who underwent acute neurosurgical evacuation. Patients with severe pre-existing neurological disorders were excluded. In an instrumental variable analysis, we compared outcomes between centres according to treatment preference, measured by the case-mix adjusted proportion DC per centre. The primary outcome was functional outcome rated by the 6-months Glasgow Outcome Scale Extended, estimated with ordinal regression as a common odds ratio (OR), adjusted for prespecified confounders. Variation in centre preference was quantified with the median odds ratio (MOR). CENTER-TBI is registered with ClinicalTrials.gov, number NCT02210221, and the Resource Identification Portal (Research Resource Identifier SCR_015582).

FINDINGS: Between December 19, 2014 and December 17, 2017, 4559 patients with traumatic brain injury were enrolled in CENTER-TBI of whom 336 (7%) underwent acute surgery for ASDH evacuation; 91 (27%) underwent DC and 245 (63%) craniotomy. The proportion primary DC within total acute surgery cases ranged from 6 to 67% with an interquartile range (IQR) of 12-26% among 46 centres; the odds of receiving a DC for prognostically similar patients in one centre versus another randomly selected centre were trebled (adjusted median odds ratio 2.7, p < 0.0001). Higher centre preference for DC over craniotomy was not associated with better functional outcome (adjusted common odds ratio (OR) per 14% [IQR increase] more DC in a centre = 0.9 [95% CI 0.7-1.1], n = 200). Primary DC was associated with more follow-on surgeries and complications [secondary cranial surgery 27% vs. 18%; shunts 11 vs. 5%]; and similar odds of in-hospital mortality (adjusted OR per 14% IQR more primary DC 1.3 [95% CI (1.0-3.4), n = 200]).

INTERPRETATION: We found substantial practice variation in the employment of DC over craniotomy for ASDH. This variation in treatment strategy did not result in different functional outcome. These findings suggest that primary DC should be restricted to salvageable patients in whom immediate replacement of the bone flap is not possible due to intraoperative brain swelling.

FUNDING: Hersenstichting Nederland for the Dutch NeuroTraumatology Quality Registry and the European Union Seventh Framework Program.

Ort, förlag, år, upplaga, sidor
Elsevier, 2023
Nyckelord
Acute subdural hematoma, Comparative effectiveness research, Craniotomy, Decompressive craniectomy, Instrumental variable analysis, Practice variation
Nationell ämneskategori
Anestesi och intensivvård
Identifikatorer
urn:nbn:se:umu:diva-221574 (URN)10.1016/j.eclinm.2023.102161 (DOI)001063167900001 ()37600483 (PubMedID)2-s2.0-85167581191 (Scopus ID)
Forskningsfinansiär
EU, FP7, Sjunde ramprogrammet, 602150
Tillgänglig från: 2024-02-27 Skapad: 2024-02-27 Senast uppdaterad: 2024-02-28Bibliografiskt granskad
Riemann, L., Mikolic, A., Maas, A., Unterberg, A. & Younsi, A. (2023). Computed tomography lesions and their association with global outcome in young people with mild traumatic brain injury. Journal of Neurotrauma, 40(11-12), 1243-1254
Öppna denna publikation i ny flik eller fönster >>Computed tomography lesions and their association with global outcome in young people with mild traumatic brain injury
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2023 (Engelska)Ingår i: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 40, nr 11-12, s. 1243-1254Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Mild traumatic brain injury (mTBI) can be accompanied by structural damage to the brain. Here, we investigated how the presence of intracranial traumatic computed tomography (CT) pathologies relates to the global functional outcome in young patients one year after mTBI. All patients with mTBI (Glasgow Coma Scale: 13-15) ≤24 years in the multi-center, prospective, observational Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study were included. Patient demographics and CT findings were assessed at admission, and the Glasgow Outcome Scale Extended (GOSE) was evaluated at 12 months follow-up. The association between a "positive CT" (at least one of the following: epidural hematoma, subdural hematoma, traumatic subarachnoid hemorrhage (tSAH), intraventricular hemorrhage, subdural collection mixed density, contusion, traumatic axonal injury) and functional outcome (GOSE) was assessed using multi-variable mixed ordinal and logistic regression models. A total of 462 patients with mTBI and initial brain CT from 46 study centers were included. The median age was 19 (17-22) years, and 322 (70%) were males. CT imaging showed a traumatic intracranial pathology in 171 patients (37%), most commonly tSAH (48%), contusions (40%), and epidural hematomas (37%). Patients with a positive CT scan were less likely to achieve a complete recovery 12 months post-injury. The presence of any CT abnormality was associated with both lower GOSE scores (odds ratio [OR]: 0.39 [0.24-0.63]) and incomplete recovery (GOSE <8; OR: 0.41 [0.25-0.68]), also when adjusted for demographical and clinical baseline factors. The presence of intracranial traumatic CT pathologies was predictive of outcome 12 months after mTBI in young patients, which might help to identify candidates for early follow-up and additional care.

Ort, förlag, år, upplaga, sidor
Mary Ann Liebert, 2023
Nyckelord
CT findings, adolescents, children, intracranial lesions, mild TBI, outcome
Nationell ämneskategori
Anestesi och intensivvård
Identifikatorer
urn:nbn:se:umu:diva-221575 (URN)10.1089/neu.2022.0055 (DOI)000938494700001 ()36578216 (PubMedID)2-s2.0-85160968721 (Scopus ID)
Forskningsfinansiär
EU, FP7, Sjunde ramprogrammet, 602150
Tillgänglig från: 2024-02-27 Skapad: 2024-02-27 Senast uppdaterad: 2024-02-28Bibliografiskt granskad
Simander, G., Dahlqvist, P., Oja, L., Eriksson, P. O., Lindvall, P. & Koskinen, L.-O. D. (2023). Intrasellar pressure is related to endocrine disturbances in patients with pituitary tumors. World Neurosurgery, 175, e344-e351
Öppna denna publikation i ny flik eller fönster >>Intrasellar pressure is related to endocrine disturbances in patients with pituitary tumors
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2023 (Engelska)Ingår i: World Neurosurgery, ISSN 1878-8750, E-ISSN 1878-8769, Vol. 175, s. e344-e351Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective: The aim of this study was to investigate the association between intraoperative intrasellar pressure (ISP) and pre- and postoperative endocrine disturbances with focus on hyperprolactinemia and hypopituitarism in patients with pituitary tumors.

Methods: The study is a consecutive, retrospective study with ISP collected prospectively. One hundred patients operated with transsphenoidal surgery due to a pituitary tumor, who had their ISP measured intraoperatively, were included. Data on patient endocrine status preoperatively and from 3-month postoperative follow-up were collected from medical records.

Results: The risk of preoperative hyperprolactinemia in patients with nonprolactinoma pituitary tumors increased with ISP (unit odds ratio 1.067, n = 70) (P = 0.041). Preoperative hyperprolactinemia was normalized at 3 months after surgery. Mean ISP was higher in patients with preoperative thyroid-stimulating hormone (TSH) deficiency (25.3 ± 9.2 mmHg, n = 37) than in patients with intact thyroid axis (21.6 ± 7.2 mmHg, n = 50) (P = 0.041). No significant difference in ISP was found between patients with and without adrenocorticotropic hormone(ACTH) deficiency. No association was found between ISP and postoperative hypopituitarism at 3 months after surgery.

Conclusions: In patients with pituitary tumors, preoperative hypothyroidism and hyperprolactinemia may be associated with higher ISP. This is in line with the theory of pituitary stalk compression, suggested to be mediated by an elevated ISP. ISP does not predict the risk of postoperative hypopituitarism 3 months after surgical treatment.

Ort, förlag, år, upplaga, sidor
Elsevier, 2023
Nyckelord
Hyperprolactinemia, Hypopituitarism, Intrasellar pressure, Pituitary adenoma
Nationell ämneskategori
Endokrinologi och diabetes
Identifikatorer
urn:nbn:se:umu:diva-206954 (URN)10.1016/j.wneu.2023.03.085 (DOI)36966914 (PubMedID)2-s2.0-85152366491 (Scopus ID)
Forskningsfinansiär
Umeå universitetRegion Västerbotten
Tillgänglig från: 2023-04-26 Skapad: 2023-04-26 Senast uppdaterad: 2023-07-13Bibliografiskt granskad
Rostami, E., Ginstman, F., Ljungqvist, J., Olivecrona, M., Koskinen, L.-O. D., Bellander, B.-M. & Marklund, N. (2023). Modern handläggning minimerar följder av traumatisk hjärnskada: behandlingsriktlinjer har tydligt reducerat mortaliteten: [Treatment of traumatic brain injury in the acute setting - an overview]. Läkartidningen, 120(4-5), Article ID 22067.
Öppna denna publikation i ny flik eller fönster >>Modern handläggning minimerar följder av traumatisk hjärnskada: behandlingsriktlinjer har tydligt reducerat mortaliteten: [Treatment of traumatic brain injury in the acute setting - an overview]
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2023 (Svenska)Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 120, nr 4-5, artikel-id 22067Artikel i tidskrift (Refereegranskat) Published
Abstract [sv]

Traumatic brain injury (TBI) is the leading cause of death among the young, and has an increasing incidence among the elderly. In Sweden there are 20 000 new TBI cases each year, of which most are mild. The primary impact can lead to different types of brain hemorrhages, fractures and diffuse axonal injuries. The level of consciousness is used to define injury severity. Of all TBIs,  4-5 percent require surgical intervention. The primary impact initiates injury processes exacerbating the initial brain injury, and the goal of the acute management and neurointensive care treatment is to prevent these secondary insults. Among unconscious TBI patients, monitoring of intracranial pressure and cerebral perfusion pressure (CPP, defined as the difference between the mean arterial pressure and intracranial pressure) is routine. In this article we present an overview on different types of TBI, and describe the treatment of patients in the acute setting.

Ort, förlag, år, upplaga, sidor
Läkartidningen Förlag, 2023
Nationell ämneskategori
Neurologi
Identifikatorer
urn:nbn:se:umu:diva-220043 (URN)36714930 (PubMedID)2-s2.0-85147060153 (Scopus ID)
Tillgänglig från: 2024-01-26 Skapad: 2024-01-26 Senast uppdaterad: 2024-03-04Bibliografiskt granskad
Mikolić, A., Steyerberg, E. W., Polinder, S., Wilson, L., Zeldovich, M., von Steinbuechel, N., . . . van Klaveren, D. (2023). Prognostic models for global functional outcome and post-concussion symptoms following mild traumatic brain injury: a collaborative european neurotrauma effectiveness research in traumatic brain injury (CENTER-TBI) study. Journal of Neurotrauma, 40(15-16), 1651-1670
Öppna denna publikation i ny flik eller fönster >>Prognostic models for global functional outcome and post-concussion symptoms following mild traumatic brain injury: a collaborative european neurotrauma effectiveness research in traumatic brain injury (CENTER-TBI) study
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2023 (Engelska)Ingår i: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 40, nr 15-16, s. 1651-1670Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

After mild traumatic brain injury (mTBI), a substantial proportion of individuals do not fully recover on the Glasgow Outcome Scale Extended (GOSE) or experience persistent post-concussion symptoms (PPCS). We aimed to develop prognostic models for the GOSE and PPCS at 6 months after mTBI and to assess the prognostic value of different categories of predictors (clinical variables; questionnaires; computed tomography [CT]; blood biomarkers). From the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, we included participants aged 16 or older with Glasgow Coma Score (GCS) 13-15. We used ordinal logistic regression to model the relationship between predictors and the GOSE, and linear regression to model the relationship between predictors and the Rivermead Post-concussion Symptoms Questionnaire (RPQ) total score. First, we studied a pre-specified Core model. Next, we extended the Core model with other clinical and sociodemographic variables available at presentation (Clinical model). The Clinical model was then extended with variables assessed before discharge from hospital: early post-concussion symptoms, CT variables, biomarkers, or all three categories (extended models). In a subset of patients mostly discharged home from the emergency department, the Clinical model was extended with 2-3-week post-concussion and mental health symptoms. Predictors were selected based on Akaike's Information Criterion. Performance of ordinal models was expressed as a concordance index (C) and performance of linear models as proportion of variance explained (R2). Bootstrap validation was used to correct for optimism. We included 2376 mTBI patients with 6-month GOSE and 1605 patients with 6-month RPQ. The Core and Clinical models for GOSE showed moderate discrimination (C = 0.68 95% confidence interval 0.68 to 0.70 and C = 0.70[0.69 to 0.71], respectively) and injury severity was the strongest predictor. The extended models had better discriminative ability (C = 0.71[0.69 to 0.72] with early symptoms; 0.71[0.70 to 0.72] with CT variables or with blood biomarkers; 0.72[0.71 to 0.73] with all three categories). The performance of models for RPQ was modest (R2 = 4% Core; R2 = 9% Clinical), and extensions with early symptoms increased the R2 to 12%. The 2-3-week models had better performance for both outcomes in the subset of participants with these symptoms measured (C = 0.74 [0.71 to 0.78] vs. C = 0.63[0.61 to 0.67] for GOSE; R2 = 37% vs. 6% for RPQ). In conclusion, the models based on variables available before discharge have moderate performance for the prediction of GOSE and poor performance for the prediction of PPCS. Symptoms assessed at 2-3 weeks are required for better predictive ability of both outcomes. The performance of the proposed models should be examined in independent cohorts.

Ort, förlag, år, upplaga, sidor
Mary Ann Liebert, 2023
Nyckelord
biomarkers, Glasgow Outcome Scale Extended, mild traumatic brain injury, post-concussion symptoms, predictors, prognostic model
Nationell ämneskategori
Neurologi
Identifikatorer
urn:nbn:se:umu:diva-216232 (URN)10.1089/neu.2022.0320 (DOI)000993931100001 ()37078144 (PubMedID)2-s2.0-85168315877 (Scopus ID)
Forskningsfinansiär
EU, FP7, Sjunde ramprogrammet, 602150
Tillgänglig från: 2023-11-06 Skapad: 2023-11-06 Senast uppdaterad: 2023-11-06Bibliografiskt granskad
Johansson, C., Aineskog, H., Koskinen, L.-O. D., Gunnarsson, A. & Lindvall, P. (2023). Serum neurofilament light as a predictor of outcome in subarachnoid haemorrhage. Acta Neurochirurgica, 165(10), 2793-2800
Öppna denna publikation i ny flik eller fönster >>Serum neurofilament light as a predictor of outcome in subarachnoid haemorrhage
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2023 (Engelska)Ingår i: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 165, nr 10, s. 2793-2800Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Prognostication of clinical outcome in patients suffering from aneurysmal subarachnoid haemorrhage (SAH) is a challenge. There are no biochemical markers in routine use that can aid in prognostication. Neurofilament light (NFL) measured in cerebrospinal fluid (CSF) has been associated with clinical outcome in previous studies.

Objective: To investigate if serum levels of NFL correlate with CSF levels and long-term clinical outcome in patients suffering from SAH.

Methods: We conducted an observational cohort study of 88 patients treated for SAH at Umeå University Hospital in 2014–2018. Serum and CSF samples were analysed using an enzyme-linked immunosorbent assay to quantify NFL levels. Outcome was assessed using Glasgow Outcome Scale Extended and dichotomised as favourable or unfavourable. Differences in NFL levels between outcome groups were analysed using repeated measurements ANOVA. Relationship between CSF and serum NFL levels was analysed using Pearson’s correlation. A multivariate binary logistic regression model and a receiver operation characteristic curve were used to assess the predictive value of serum NFL.

Results: A significant correlation between serum and CSF-NFL levels could be seen (Pearson’s correlation coefficient = 0.7, p <.0001). Mean level of serum NFL was higher in the unfavourable outcome group than the favourable outcome group (p <.0001), in all epochs of SAH, and correlated with initial disease severity on the World Federation of Neurosurgical Societies scale. Serum NFL in the late phase displayed the best predictive potential in a receiver operation characteristic curve analysis (AUC=0.845, p <.0001).

Conclusion: Levels of NFL in serum and CSF are correlated. Early serum NFL levels seem to reflect initial tissue damage and serum NFL levels in the late phase may reflect secondary events such as vasospasm or delayed cerebral ischemia. Serum NFL may be used as a prognostic marker of clinical outcome in SAH.

Ort, förlag, år, upplaga, sidor
Springer, 2023
Nyckelord
Cerebral vasospasm, Glasgow Outcome Scale, Neurofilament protein l, Subarachnoid haemorrhage
Nationell ämneskategori
Neurologi Neurovetenskaper
Identifikatorer
urn:nbn:se:umu:diva-211994 (URN)10.1007/s00701-023-05673-9 (DOI)001019458300001 ()37351672 (PubMedID)2-s2.0-85163214143 (Scopus ID)
Tillgänglig från: 2023-07-12 Skapad: 2023-07-12 Senast uppdaterad: 2023-12-12Bibliografiskt granskad
Kals, M., Kunzmann, K., Parodi, L., Radmanesh, F., Wilson, L., Izzy, S., . . . Menon, D. K. (2022). A genome-wide association study of outcome from traumatic brain injury. EBioMedicine, 77, Article ID 103933.
Öppna denna publikation i ny flik eller fönster >>A genome-wide association study of outcome from traumatic brain injury
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2022 (Engelska)Ingår i: EBioMedicine, E-ISSN 2352-3964, Vol. 77, artikel-id 103933Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND: Factors such as age, pre-injury health, and injury severity, account for less than 35% of outcome variability in traumatic brain injury (TBI). While some residual outcome variability may be attributable to genetic factors, published candidate gene association studies have often been underpowered and subject to publication bias.

METHODS: We performed the first genome- and transcriptome-wide association studies (GWAS, TWAS) of genetic effects on outcome in TBI. The study population consisted of 5268 patients from prospective European and US studies, who attended hospital within 24 h of TBI, and satisfied local protocols for computed tomography.

FINDINGS: The estimated heritability of TBI outcome was 0·26. GWAS revealed no genetic variants with genome-wide significance (p < 5 × 10-8), but identified 83 variants in 13 independent loci which met a lower pre-specified sub-genomic statistical threshold (p < 10-5). Similarly, none of the genes tested in TWAS met tissue-wide significance. An exploratory analysis of 75 published candidate variants associated with 28 genes revealed one replicable variant (rs1800450 in the MBL2 gene) which retained significance after correction for multiple comparison (p = 5·24 × 10-4).

INTERPRETATION: While multiple novel loci reached less stringent thresholds, none achieved genome-wide significance. The overall heritability estimate, however, is consistent with the hypothesis that common genetic variation substantially contributes to inter-individual variability in TBI outcome. The meta-analytic approach to the GWAS and the availability of summary data allows for a continuous extension with additional cohorts as data becomes available.

FUNDING: A full list of funding bodies that contributed to this study can be found in the Acknowledgements section.

Ort, förlag, år, upplaga, sidor
Elsevier, 2022
Nyckelord
Consortia, Genome-Wide association study, Outcome, Recovery, Traumatic brain injury
Nationell ämneskategori
Anestesi och intensivvård
Identifikatorer
urn:nbn:se:umu:diva-215813 (URN)10.1016/j.ebiom.2022.103933 (DOI)000795901400017 ()35301180 (PubMedID)2-s2.0-85126327411 (Scopus ID)
Tillgänglig från: 2023-10-26 Skapad: 2023-10-26 Senast uppdaterad: 2023-10-27Bibliografiskt granskad
Magnusson, B. M., Isaksson, E. & Koskinen, L.-O. D. (2022). A prospective observational cohort study of traumatic brain injury in the northern region of Sweden. Brain Injury, 36(2), 191-198
Öppna denna publikation i ny flik eller fönster >>A prospective observational cohort study of traumatic brain injury in the northern region of Sweden
2022 (Engelska)Ingår i: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 36, nr 2, s. 191-198Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVE: Generally, to map epidemiological and demographic features of patients with traumatic brain injury (TBI) in Umeå county, Sweden. Specifically, to evaluate the subjects needing a computed tomography (CT) of the head after suffering from TBI and frequencies of 1) intracranial lesions detected with CT, 2) need for neurosurgical intervention and 3) admission to hospital.

METHODS: Patients with a suspected TBI, undergoing CT within 24 hours of arrival to hospital, were included in a database for evaluation.

RESULTS: Out of 302 patients (63% male), 83% were GCS 13-15, 7% were GCS 9-12 and 10% were GCS <9. The frequency of abnormal CT findings was 23% in GCS 13-15, 67% in GCS 9-12 and 97% in GCS <9. Neurosurgical intervention was needed by 4% of those with GCS 13-15, 52% of those with GCS 9-12 and by 76% of those with GCS <9.

CONCLUSIONS: Subjects with GCS 13-15  had higher frequencies of abnormal CT findings, need for neurosurgical intervention and hospital admission than previously reported. A similar trend was observed for patients with GCS 9-12, which can be of serious nature, with a higher frequency of need for neurosurgical intervention than previously described.

Ort, förlag, år, upplaga, sidor
Taylor & Francis, 2022
Nyckelord
CT scan, Traumatic brain injury, demographics, glasgow coma scale, intervention, outcome
Nationell ämneskategori
Neurologi
Identifikatorer
urn:nbn:se:umu:diva-203262 (URN)10.1080/02699052.2022.2034952 (DOI)000751693600001 ()35125045 (PubMedID)2-s2.0-85124365655 (Scopus ID)
Tillgänglig från: 2023-01-17 Skapad: 2023-01-17 Senast uppdaterad: 2023-03-24Bibliografiskt granskad
Organisationer
Identifikatorer
ORCID-id: ORCID iD iconorcid.org/0000-0003-3528-8502

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