Effects of early high-dose vasopressor administration in patients after aneurysmal subarachnoid hemorrhage: a retrospective single-center study

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Acta Neurochirurgica Pub Date : 2025-03-17 DOI:10.1007/s00701-025-06435-5

Jan Küchler, Niclas Hinselmann, Maria V. Matone, Anastassia Löser, Volker M. Tronnier, Claudia Ditz

{"title":"Effects of early high-dose vasopressor administration in patients after aneurysmal subarachnoid hemorrhage: a retrospective single-center study","authors":"Jan Küchler, Niclas Hinselmann, Maria V. Matone, Anastassia Löser, Volker M. Tronnier, Claudia Ditz","doi":"10.1007/s00701-025-06435-5","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Although the use of vasopressors is recommended after aneurysmal subarachnoid hemorrhage (aSAH) to maintain adequate cerebral perfusion pressure, data on potential adverse effects on delayed cerebral ischemia (DCI) are lacking. The aim of this study was to evaluate the effects of early high-dose vasopressor therapy with norepinephrine alone or additional vasopressin on the subsequent occurrence of DCI, DCI-related infarction and functional outcomes.</p><h3>Methods</h3><p>Retrospective evaluation of aSAH patients admitted between January 2010 and December 2022. Demographic, clinical and outcome data as well as daily norepinephrine equivalent (NEE) scores were collected. Potential risk factors for DCI, DCI-related infarction and functional outcome 3 months after discharge were assessed by logistic regression analyses.</p><h3>Results</h3><p>A total of 288 patients were included. 208 patients (72%) received vasopressor therapy during the first 14 postictal days with a mean NEE score of 3.8 µg/kgBW/h. The highest NEE scores were observed in the acute phase after hemorrhage and mainly in poor-grade patients. The mean NEE score during the postictal days 1–4 was significantly higher in patients who developed DCI or DCI-related infarction and who had an unfavorable functional outcome. Multivariable logistic regression analysis identified a high NEE score on postictal days 1–4 as an independent predictor of DCI and unfavorable functional outcome.</p><h3>Conclusions</h3><p>Vasopressor use is common in aSAH patients in the acute phase after hemorrhage. Our results suggest that high NEE scores during the first 4 days after ictus represent an independent prognostic factor and might aggravate the complex cerebral sequelae associated with the disease.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06435-5.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta Neurochirurgica","FirstCategoryId":"3","ListUrlMain":"https://link.springer.com/article/10.1007/s00701-025-06435-5","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Although the use of vasopressors is recommended after aneurysmal subarachnoid hemorrhage (aSAH) to maintain adequate cerebral perfusion pressure, data on potential adverse effects on delayed cerebral ischemia (DCI) are lacking. The aim of this study was to evaluate the effects of early high-dose vasopressor therapy with norepinephrine alone or additional vasopressin on the subsequent occurrence of DCI, DCI-related infarction and functional outcomes.

Methods

Retrospective evaluation of aSAH patients admitted between January 2010 and December 2022. Demographic, clinical and outcome data as well as daily norepinephrine equivalent (NEE) scores were collected. Potential risk factors for DCI, DCI-related infarction and functional outcome 3 months after discharge were assessed by logistic regression analyses.

Results

A total of 288 patients were included. 208 patients (72%) received vasopressor therapy during the first 14 postictal days with a mean NEE score of 3.8 µg/kgBW/h. The highest NEE scores were observed in the acute phase after hemorrhage and mainly in poor-grade patients. The mean NEE score during the postictal days 1–4 was significantly higher in patients who developed DCI or DCI-related infarction and who had an unfavorable functional outcome. Multivariable logistic regression analysis identified a high NEE score on postictal days 1–4 as an independent predictor of DCI and unfavorable functional outcome.

Conclusions

Vasopressor use is common in aSAH patients in the acute phase after hemorrhage. Our results suggest that high NEE scores during the first 4 days after ictus represent an independent prognostic factor and might aggravate the complex cerebral sequelae associated with the disease.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Acta Neurochirurgica 医学-临床神经学

CiteScore

4.40

自引率

4.20%

发文量

342

审稿时长

1 months

期刊介绍： The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.