TY - JOUR TI - Topological network analysis of patient similarity for precision management of acute blood pressure in spinal cord injury AU - Torres-Espín, Abel AU - Haefeli, Jenny AU - Ehsanian, Reza AU - Torres, Dolores AU - Almeida, Carlos A AU - Huie, J Russell AU - Chou, Austin AU - Morozov, Dmitriy AU - Sanderson, Nicole AU - Dirlikov, Benjamin AU - Suen, Catherine G AU - Nielson, Jessica L AU - Kyritsis, Nikos AU - Hemmerle, Debra D AU - Talbott, Jason F AU - Manley, Geoffrey T AU - Dhall, Sanjay S AU - Whetstone, William D AU - Bresnahan, Jacqueline C AU - Beattie, Michael S AU - McKenna, Stephen L AU - Pan, Jonathan Z AU - Ferguson, Adam R AU - The TRACK-SCI Investigators A2 - Mangoni, Arduino A A2 - Barton, Matthias A2 - Kopp, Marcel A2 - Phillips, Aaron VL - 10 PY - 2021 DA - 2021/11/16 SP - e68015 C1 - eLife 2021;10:e68015 DO - 10.7554/eLife.68015 UR - https://doi.org/10.7554/eLife.68015 AB - Background:. Predicting neurological recovery after spinal cord injury (SCI) is challenging. Using topological data analysis, we have previously shown that mean arterial pressure (MAP) during SCI surgery predicts long-term functional recovery in rodent models, motivating the present multicenter study in patients. Methods:. Intra-operative monitoring records and neurological outcome data were extracted (n = 118 patients). We built a similarity network of patients from a low-dimensional space embedded using a non-linear algorithm, Isomap, and ensured topological extraction using persistent homology metrics. Confirmatory analysis was conducted through regression methods. Results:. Network analysis suggested that time outside of an optimum MAP range (hypotension or hypertension) during surgery was associated with lower likelihood of neurological recovery at hospital discharge. Logistic and LASSO (least absolute shrinkage and selection operator) regression confirmed these findings, revealing an optimal MAP range of 76–[104-117] mmHg associated with neurological recovery. Conclusions:. We show that deviation from this optimal MAP range during SCI surgery predicts lower probability of neurological recovery and suggest new targets for therapeutic intervention. Funding:. NIH/NINDS: R01NS088475 (ARF); R01NS122888 (ARF); UH3NS106899 (ARF); Department of Veterans Affairs: 1I01RX002245 (ARF), I01RX002787 (ARF); Wings for Life Foundation (ATE, ARF); Craig H. Neilsen Foundation (ARF); and DOD: SC150198 (MSB); SC190233 (MSB); DOE: DE-AC02-05CH11231 (DM). KW - topological networks analysis KW - spinal cord injury KW - blood pressure KW - machine learning KW - surgery JF - eLife SN - 2050-084X PB - eLife Sciences Publications, Ltd ER -