Marek Sykora1, Sahra Steinmacher2, Thorsten Steiner3, Sven Poli4, Jennifer Diedler5. 1. Department of Neurology, University of Heidelberg, Heidelberg, Germany. Electronic address: marek.sykora@med.uni-heidelberg.de. 2. Department of Neurology, University of Heidelberg, Heidelberg, Germany. 3. Department of Neurology, Klinikum Frankfurt Höchst, Frankfurt am Main, Germany. 4. Department of Neurology, University of Heidelberg, Heidelberg, Germany; Department of Neurology, University of Tübingen, Tübingen, Germany. 5. Department of Neurology, University of Heidelberg, Heidelberg, Germany; Department of Neurology, University of Tübingen, Tübingen, Germany; Department of Neurosurgery, University of Tübingen, Tübingen, Germany.
Abstract
BACKGROUND: Therapeutic targets for intracranial pressure (ICP) in patients with severe intracerebral hemorrhage (ICH) are approximated from data of traumatic brain injury. However, specific data for ICH are lacking. Here, we aimed to investigate the association between ICP, mortality and functional outcome following severe ICH. METHODS: We analyzed consecutive comatose patients with ICH in whom ICP monitoring was applied. Outcome at 3 months was assessed using the modified Rankin scale (mRS). Multivariate logistic regression including pre-defined predictors was used in order to identify the effects of ICP on outcome. RESULTS: 121 patients with ICH and ICP monitoring were analyzed. Mean ICP (OR 1.2, CI 1.08-1.45, p=0.003), ICP variability (OR 1.3, CI 1.03-1.73, p=0.03) and relative frequency of ICP values >20 mm Hg (OR 1.1, CI 1.02- 1.15, p=0.008) were independently associated with mortality at 3 months. Relative frequency of ICP values >20 mm Hg (OR 1.1, CI 1.001-1.3, p=0.04) was associated also with poor functional outcome at 3 months. CONCLUSIONS: Our data suggest that in the context of other predictors as age, admission clinical status, hemorrhage volume and intraventricular hemorrhage, average ICP, ICP variability and the frequency of ICP values >20 mm Hg are independently associated with mortality and poor outcome after ICH. Further studies and prospective validations of ICP thresholds for ICH patients are highly warranted.
BACKGROUND: Therapeutic targets for intracranial pressure (ICP) in patients with severe intracerebral hemorrhage (ICH) are approximated from data of traumatic brain injury. However, specific data for ICH are lacking. Here, we aimed to investigate the association between ICP, mortality and functional outcome following severe ICH. METHODS: We analyzed consecutive comatosepatients with ICH in whom ICP monitoring was applied. Outcome at 3 months was assessed using the modified Rankin scale (mRS). Multivariate logistic regression including pre-defined predictors was used in order to identify the effects of ICP on outcome. RESULTS: 121 patients with ICH and ICP monitoring were analyzed. Mean ICP (OR 1.2, CI 1.08-1.45, p=0.003), ICP variability (OR 1.3, CI 1.03-1.73, p=0.03) and relative frequency of ICP values >20 mm Hg (OR 1.1, CI 1.02- 1.15, p=0.008) were independently associated with mortality at 3 months. Relative frequency of ICP values >20 mm Hg (OR 1.1, CI 1.001-1.3, p=0.04) was associated also with poor functional outcome at 3 months. CONCLUSIONS: Our data suggest that in the context of other predictors as age, admission clinical status, hemorrhage volume and intraventricular hemorrhage, average ICP, ICP variability and the frequency of ICP values >20 mm Hg are independently associated with mortality and poor outcome after ICH. Further studies and prospective validations of ICP thresholds for ICHpatients are highly warranted.
Authors: Daniel Agustín Godoy; Rafael A Núñez-Patiño; Andres Zorrilla-Vaca; Wendy C Ziai; J Claude Hemphill Journal: Neurocrit Care Date: 2019-08 Impact factor: 3.210