Artikel
Duration of intracranial pressure increase after aneurysmal subarachnoid haemorrhage – early predictors and association with the outcome
Dauer des intrakraniellen Druckanstiegs nach aneurysmatischer Subarachnoidalblutung: frühzeitige Prädiktoren und Zusammenhang mit dem Outcome
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Veröffentlicht: | 25. Mai 2022 |
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Gliederung
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Objective: Rupture of intracranial aneurysm is associated with several primary and secondary complications, including a persistent increase of intracranial pressure (ICP) requiring conservative and/or surgical treatment. We analyzed the risk factors related to the duration of pathological ICP increase and the relationship between ICP burden and SAH outcome.
Methods: All consecutive cases with aneurysmal subarachnoid hemorrhage (SAH) treated at our institution between 01/2003 and 06/2016 were eligible for this study. Different admission variables were analyzed to predict the prediction of the duration of ICP >20 mmHg in univariate and multivariate analyses. The association of ICP course with the primary study endpoints (risk of cerebral infarction, in-hospital mortality and unfavorable outcome at 6 months defined as modified Rankin scale>3) were adjusted for major outcome-relevant confounders.
Results: Of 912 SAH patients in the final analysis, 386 individuals (42.3%) developed at least one ICP increase requiring conservative and/or surgical management after aneurysm treatment (mean duration: 3.84 days, range: 1 – 14 days). In the multivariate analysis, patients’ age (UC=-0.02, p<0.0001), WFNS (UC=0.94, p<0.0001) and Fisher (UC=0.71, p=0.002) grades at admission, regular medication with the angiotensin-converting enzyme inhibitors (UC=-0.42, p=0.027), and blood sugar levels (UC=0.01, p=0.037) were associated with the duration of ICP increase. In turn, patients with longer ICP elevations were at higher risk for cerebral infarction (aOR=1.31 per-day-increase, p<0.0001), in-hospital mortality (aOR=1.19, p<0.0001) and unfavorable outcome (aOR=1.43, p<0.0001). SAH patients who underwent primary decompression showed a shorter period of ICP increase than the counterparts with secondary decompression (mean: 2.7 vs 4.8 days, p<0.0001).
Conclusion: The duration of ICP increase after aneurysm rupture is a strong outcome predictor and 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 optimizing ICP management and outcome improvement.