Intracranial pressure variability associates with 3-month outcomes in spontaneous intracerebral hemorrhage: a retrospective analysis of 597 patients.

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery Pub Date : 2024-09-05 DOI:10.1016/j.wneu.2024.09.001

Lei Yang, Mei-Hua Wang, Jie Song, Yi-Feng Bao, Qiang Yuan, Yue Wang, Jin Hu, Jian Yu, Gang Wu, Jian-Lan Zhao

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引用次数: 0

Abstract

Background and objective: Spontaneous intracerebral hemorrhage (ICH) is a devastating type of stroke but most favorable treatments to improve patients' neurological outcomes are not clear. Invasive intracranial pressure (ICP) monitoring is a common treatment of ICH, but whether ICH patients could benefit from ICP monitoring is controversial. ICP variability (IPV) has been shown to correlate with poor outcomes in patients with subarachnoid hemorrhage (SAH) and traumatic brain injury (TBI), but this association has not been clearly elucidated in ICH patients. We hypothesized that 72 hour-IPV from time of ICP probe implantation is associated with outcomes in ICH patients.

Methods: A retrospective chart review analysis of adult ICH patients, who received ICP monitoring at Huashan Hospital Fudan University between Jan. 2008 and Jan. 2023, was performed. We included ICH patients within 6 hours of signs or symptoms onset. Outcomes of ICH patients were assessed using 3-month mRS, and were dichotomized into poor (mRS 4 to 6) and good (mRS 0 to 3) outcome group. ICPs were recorded from the implantation of invasive ICP probe until it was removed. ICP was analyzed in the acute period, from 0 to 72 hours after ICP implantation. IPV was analyzed by SD (Standard deviation), CV (Coefficient of variation) and SV (Successive variation) of ICP.

Results: We analyzed 597 patients' charts. The 1^st ICP assessment, immediately after ICP implantation, at median 117 minutes (interquartile range, 82-231 minutes) after admission was mean 20.5±7.8 mmHg. The 2^nd ICP assessment, on NICU arrival after operation, was mean 14.6±8.3 mmHg. Poor outcomes occurred in 213 patients (35.68%). In univariate analysis, univariate quintile analysis or multivariate analysis, ICP_SD, ICP_CV and ICP_SV were associated with poor outcomes.

Conclusions: IPV during the first 72 hours after ICP implantation in patients with ICH was independently associated with poor functional outcome at 3-month. Stabilization of IPV during hyperacute and acute period maybe a potential therapeutic target to improve functional outcomes of these patients.

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颅内压变异与自发性脑出血 3 个月预后的关系：对 597 例患者的回顾性分析。

背景和目的：自发性脑内出血（ICH）是一种破坏性脑卒中，但改善患者神经功能预后的最有效治疗方法尚不明确。有创颅内压（ICP）监测是治疗 ICH 的常用方法，但 ICH 患者是否能从 ICP 监测中获益尚存争议。ICP变异性（IPV）已被证明与蛛网膜下腔出血（SAH）和创伤性脑损伤（TBI）患者的不良预后相关，但这种关联在 ICH 患者中尚未得到明确阐明。我们假设，从植入 ICP 探针时算起 72 小时内的 IV 值与 ICH 患者的预后有关：我们对 2008 年 1 月至 2023 年 1 月期间在复旦大学附属华山医院接受 ICP 监测的成人 ICH 患者进行了回顾性病历分析。我们纳入了症状或体征出现后 6 小时内的 ICH 患者。ICH 患者的预后通过 3 个月的 mRS 进行评估，并分为预后差（mRS 4 至 6）和预后好（mRS 0 至 3）两组。从植入有创ICP探针到取出探针，均记录ICP值。ICP分析时间为植入ICP后0至72小时的急性期。IPV通过ICP的SD（标准差）、CV（变异系数）和SV（连续变异）进行分析：我们分析了 597 名患者的病历。入院后 117 分钟（四分位数间距，82-231 分钟）ICP 植入后立即进行的第一次 ICP 评估的平均值为 20.5±7.8 mmHg。手术后到达重症监护室时进行的第二次 ICP 评估的平均值为 14.6±8.3 mmHg。有 213 名患者（35.68%）出现不良预后。在单变量分析、单变量五分位分析或多变量分析中，ICPPSD、ICPCV 和 ICPSV 与不良预后相关：ICH 患者植入 ICP 后 72 小时内的 IPV 与 3 个月后的不良功能预后密切相关。在超急性期和急性期稳定 IPV 可能是改善这些患者功能预后的潜在治疗目标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World neurosurgery CLINICAL NEUROLOGY-SURGERY

CiteScore

3.90

自引率

15.00%

发文量

1765

审稿时长

47 days

期刊介绍： World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS