Four Distinct Dynamic Intracranial Pressure Trajectories and Their Prognostic Implications in Acute Brain Injury - A Multicenter Cohort Study

Sep 28, 2026

Acute brain injury frequently elevates intracranial pressure (ICP), yet reliance on static measurements can miss dynamic risk patterns. This multicenter cohort study used ICU data from MIMIC-IV, eICU, and NSICU to derive early ICP trajectories over the first 120 hours via latent class growth modeling. Associations with in-hospital mortality were evaluated with Cox models and incremental prognostic performance assessed using AUC, IDI, and NRI, with sensitivity analyses across datasets and age groups.

LanguageEnglish

CategoryHealthcare

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Pages11

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CNS Neuroscience & Therapeutics |
ORIGINAL ARTICLE OPEN ACCESS
Four Distinct Dynamic Intracranial Pressure Trajectories and Their Prognostic Implications in Acute Brain Injury: A Multicenter Cohort Study
Juan Wang1,2,3 | Haibo Li4 | Manman Xu1,2,3 | Wen-Juan Li5 | Longyang Cheng2,3 | Shaoya Li2,3 | Chun-Hua Hang1,2,3 | Penglai Zhao1,2,3
1Department of Neurosurgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing University of Chinese Medicine, Nanjing, China | 2Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing,
China | 3Neurosurgical Institute, Nanjing University, Nanjing, China | 4Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China | 5Center for Medical Big Data, Nanjing Drum Tower Hospital, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
Correspondence: Chun-Hua Hang ([hang_neurosurgery@163.com](hang_neurosurgery@163.com)) | Penglai Zhao ([13382760868@163.com](13382760868@163.com))
Received: 12 July 2025 | Revised: 3 November 2025 | Accepted: 22 December 2025
Keywords: acute brain injury | ICP trajectories | latent class growth modeling | mortality prediction | risk stratification | | | --- | --- | | ABSTRACT
Background: Acute brain injury (ABI) often elevates intracranial pressure (ICP), yet static measurements miss dynamic risk. We evaluated the prognostic value of early ICP trajectories.
Methods: We formed a multicenter ICU cohort from MIMIC-IV (2008–2022), eICU (2014–2015), and NSICU (2024–2025) . Latent class growth modeling identified ICP trajectories over the first 120 h. Associations with in-hospital mortality were tested with Cox models, and incremental value beyond baseline clinical variables was quantified by AUC, integrated discrimination improvement (IDI), and net reclassification improvement (NRI) . Sensitivity analyses were performed across datasets and age groups.
Results: Among 1700 patients with ABI, four trajectories emerged—Severe Progressive, Stabilized Elevated, Mildly Elevated Stable, and Normal. Versus Normal, mortality risk was highest for Severe Progressive (HR 13.54; 95% CI 9.35–19.59), followed by Stabilized Elevated (HR 2.53; 1.83–3.49) and Mildly Elevated Stable (HR 1.48; 1.16–1.91) . In patients aged ≥55years, risk with Stabilized Elevated was amplified (HR 2.87; 1.97–4.20). Adding trajectories improved risk stratification (IDI +0.065; NRI +0.201) with modest AUC gains.
Conclusions: Early ICP trajectories define reproducible phenotypes with distinct mortality risk. Incorporating trajectories—particularly the stabilized-elevated pattern in older adults—adds prognostic value beyond clinical variables and supports prospective validation. | | | 1 | Introduction | injury (TBI), intracerebral hemorrhage (ICH), and ischemic | | Intracranial pressure (ICP) elevation frequently occurs in patients with acute brain injury (ABI), including traumatic brain | stroke [1, 2] . Prolonged elevated ICP can lead to severe complications such as cerebral herniation and impaired cerebral perfusion, significantly impacting survival and neurological | | Juan Wang and Haibo Li contributed equally to this article. | | | This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
© 2026 The Author(s). CNS Neuroscience & Therapeutics published by John Wiley & Sons Ltd. | | CNS Neuroscience & Therapeutics, 2026; 32:e70735 1 of 11 [https://doi.org/10.1002/cns.70735](https://doi.org/10.1002/cns.70735) recovery [3] . Inadequate ICP management in neurocritical care may exacerbate secondary brain injury, worsening prognosis and long-term outcomes [4] . Thus, accurate ICP mon

FAQs

What was the study goal regarding intracranial pressure (ICP)?

To evaluate whether early, dynamic ICP trajectory patterns provide prognostic information for in-hospital mortality in acute brain injury, beyond static or fixed-threshold measurements.

How were the ICP trajectories identified?

The study used latent class growth modeling to classify ICP trajectory patterns over the first 120 hours in a multicenter ICU cohort.

What trajectory patterns were found and how did they relate to mortality risk?

Four trajectories emerged: Severe Progressive, Stabilized Elevated, Mildly Elevated Stable, and Normal. Mortality risk was highest in Severe Progressive versus Normal, followed by Stabilized Elevated and Mildly Elevated Stable.

Sep 28, 2026

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