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Four Distinct Dynamic Intracranial Pressure Trajectories and Their Prognostic Implications in Acute Brain Injury: A
Juan Wang1,2,3, Haibo Li4, Manman Xu1,2,3
1Department of Neurosurgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing University of Chinese Medicine, Nanjing, China.
CNS Neuroscience & Therapeutics
|January 3, 2026
Summary
Early intracranial pressure (ICP) trajectories in acute brain injury (ABI) predict mortality risk. Identifying specific ICP patterns, especially in older adults, improves patient prognostication beyond standard clinical data.
Area of Science:
- Neurology
- Critical Care Medicine
- Biostatistics
Background:
- Acute brain injury (ABI) management often focuses on intracranial pressure (ICP).
- Static ICP measurements may not capture dynamic risk factors.
- Evaluating early ICP trends offers prognostic insights.
Purpose of the Study:
- To investigate the prognostic value of early intracranial pressure (ICP) trajectories in patients with acute brain injury (ABI).
- To identify distinct ICP patterns and their association with in-hospital mortality.
- To assess the added value of ICP trajectories in risk stratification.
Main Methods:
- A multicenter cohort study using ICU data (MIMIC-IV, eICU, NSICU).
- Latent class growth modeling to identify ICP trajectories within the first 120 hours.
- Cox proportional hazards models and measures of risk reclassification (AUC, IDI, NRI) to assess mortality associations.
Main Results:
- Four distinct ICP trajectories were identified: Severe Progressive, Stabilized Elevated, Mildly Elevated Stable, and Normal.
- The Severe Progressive trajectory showed the highest mortality risk (HR 13.54), followed by Stabilized Elevated (HR 2.53) and Mildly Elevated Stable (HR 1.48) compared to Normal.
- The Stabilized Elevated trajectory conferred amplified risk in older adults (≥55 years, HR 2.87).
- ICP trajectories significantly improved risk stratification (IDI +0.065, NRI +0.201).
Conclusions:
- Early ICP trajectories represent distinct phenotypes of acute brain injury with varying mortality risks.
- The stabilized-elevated ICP pattern is particularly associated with increased mortality in older adults.
- Incorporating ICP trajectory analysis enhances prognostic accuracy beyond traditional clinical variables.
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