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. 2022 May 6;12(5):609.
doi: 10.3390/brainsci12050609.

Neurological Pupil Index for the Early Prediction of Outcome in Severe Acute Brain Injury Patients

Federico Romagnosi  1   2 , Adriano Bernini  1 , Filippo Bongiovanni  1   3 , Carolina Iaquaniello  1   4 , John-Paul Miroz  1 , Giuseppe Citerio  5 , Fabio Silvio Taccone  6 , Mauro Oddo  1   7
Affiliations

Neurological Pupil Index for the Early Prediction of Outcome in Severe Acute Brain Injury Patients

Federico Romagnosi et al. Brain Sci. .

Abstract

In this study, we examined the early value of automated quantitative pupillary examination, using the Neurological Pupil index (NPi), to predict the long-term outcome of acute brain injured (ABI) patients. We performed a single-centre retrospective study (October 2016−March 2019) in ABI patients who underwent NPi measurement during the first 3 days following brain insult. We examined the performance of NPi—alone or in combination with other baseline demographic (age) and radiologic (CT midline shift) predictors—to prognosticate unfavourable 6-month outcome (Glasgow Outcome Scale 1−3). A total of 145 severely brain-injured subjects (65 traumatic brain injury, TBI; 80 non-TBI) were studied. At each time point tested, NPi <3 was highly predictive of unfavourable outcome, with highest specificity (100% (90−100)) at day 3 (sensitivity 24% (15−35), negative predictive value 36% (34−39)). The addition of NPi, from day 1 following ABI to age and cerebral CT scan, provided the best prognostic performance (AUROC curve 0.85 vs. 0.78 without NPi, p = 0.008; DeLong test) for 6-month neurological outcome prediction. NPi, assessed at the early post-injury phase, has a superior ability to predict unfavourable long-term neurological outcomes in severely brain-injured patients. The added prognostic value of NPi was most significant when complemented with baseline demographic and radiologic information.

Keywords: Neurological Pupil index; acute brain injury; midline shift; neurological prognosis; quantitative pupillometry.

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Conflict of interest statement

M.O. is a consultant and member of the Scientific Advisory Board of Neuroptics. G.C. reports grants and personal fees as speakers’ bureau member and advisory board member of Integra and Neuroptics, all outside the submitted paper. F.S.T. received lecture fees from BD and ZOLL and personal fees as an advisory board member of Nihon Khoden and Neuroptics, all outside the submitted paper. All the remaining authors declare that they have no competing interests related to this study. The device manufacturer (Neuroptics, Laguna Hills, CA, USA) did not provide any financial support for the study and had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Study flowchart. Abbreviations: NPi: Neurological Pupil index.
Figure 2
Figure 2
NPi pattern during the first 3 days after ICU admission according to 6-month Glasgow Outcome Score (mean + 95%CI). Abbreviations: NPi = Neurological Pupil index, GOS: Glasgow outcome scale, ICU: intensive care unit.
Figure 3
Figure 3
Prognostic performance of NPi and midline shift at day 1. The receiver operator characteristic curve (AUROC) shows the prognostic performance scores using the combination of MS + age (AUROC curve, 0.78) in comparison with NPi day 1 + MS + age (AUROC curve, 0.85; DeLong test p = 0.008). Abbreviations: AUROC: area under receiver operating characteristics, MS: midline shift, NPi: Neurological Pupil index.
See this image and copyright information in PMC

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