Duration of Intracranial Pressure Increase after Aneurysmal Subarachnoid Hemorrhage: Prognostic Factors and Association with the Outcome.

Pikria Ketelauri, Meltem Gümüs, Hanah Hadice Gull, Maryam Said, Laurel Rauschenbach, Thiemo Florin Dinger, Mehdi Chihi, Marvin Darkwah Oppong, Yahya Ahmadipour, Philipp Dammann, Karsten Henning Wrede, Ulrich Sure, Ramazan Jabbarli
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Abstract

Objective: A rupture of the intracranial aneurysm is frequently complicated, with an increase of intracranial pressure (ICP) requiring conservative and/or surgical treatment. We analyzed the risk factors related to the duration of pathologic ICP increase and the relationship between ICP burden and the outcome of subarachnoid hemorrhage (SAH).

Methods: Consecutive cases with aneurysmal SAH treated at our institution between 01/2003 and 06/2016 were eligible for this study. Different admission variables were evaluated to predict the duration of ICP increase >20 mmHg in univariate and multivariate analyses. The association of the ICP course with SAH outcome parameters (risk of cerebral infarction, in-hospital mortality, and unfavorable outcome at 6 months defined as modified Rankin scale >3) was adjusted for major outcome-relevant confounders.

Results: Of 820 SAH patients, 378 individuals (46.1%) developed at least one ICP increase requiring conservative and/or surgical management after aneurysm treatment (mean duration: 1.76 days, range: 1 - 14 days). In the multivariable linear regression analysis, patients' age (unstandardized coefficient [UC]=-0.02, p <0.0001), World Federation of Neurosurgical Societies (WFNS) grade 4-5 at admission (UC=0.71, p <0.004), regular medication with the angiotensinconverting enzyme (ACE) inhibitors (UC=-0.61, p =0.01), and presence of intracerebral hemorrhage (UC=0.59, p =0.002) were associated with the duration of ICP increase. In turn, patients with longer ICP elevations were at higher risk for cerebral infarction (adjusted odds ratio [aOR]=1.32 per-day-increase, p <0.0001), in-hospital mortality (aOR=1.30, p <0.0001) and unfavorable outcome (aOR=1.43, p <0.0001). SAH patients who underwent primary decompressive craniectomy (DC) showed shorter periods of ICP increase than patients with a secondary decompression (mean: 2.8 vs 4.9 days, p <0.0001).

Conclusion: The duration of ICP increase after aneurysm rupture is a strong outcome predictor and is related to younger age and higher initial severity of SAH. Further analysis of the factors impacting the course of ICP after SAH is essential for the optimization of ICP management and outcome improvement.

动脉瘤性蛛网膜下腔出血后颅内压升高的持续时间:预后因素及其与预后的关系
目的:颅内动脉瘤破裂通常比较复杂,颅内压(ICP)升高需要保守和/或手术治疗。我们分析了与病理性 ICP 增高持续时间相关的风险因素,以及 ICP 负担与蛛网膜下腔出血(SAH)预后之间的关系:方法:2003年1月至2016年6月在我院接受治疗的动脉瘤性SAH连续病例均符合本研究的条件。在单变量和多变量分析中,对不同的入院变量进行了评估,以预测ICP升高>20 mmHg的持续时间。ICP持续时间与SAH预后参数(脑梗死风险、院内死亡风险和6个月时的不良预后,即改良Rankin量表>3)之间的关系已根据主要预后相关混杂因素进行了调整:在820名SAH患者中,有378人(46.1%)在动脉瘤治疗后出现至少一次ICP增高,需要保守和/或手术治疗(平均持续时间:1.76天,范围:1 - 14天)。在多变量线性回归分析中,患者的年龄(非标准化系数 [UC]=-0.02, p 结论:患者的年龄与动脉瘤治疗后 ICP 增高的持续时间有关:动脉瘤破裂后 ICP 增高的持续时间是一个很强的结果预测因子,与年龄较小、SAH 初始严重程度较高有关。进一步分析影响 SAH 后 ICP 病程的因素对于优化 ICP 管理和改善预后至关重要。.
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