Effect of blood pressure variability during the acute period of subarachnoid hemorrhage on functional outcomes

TY - JOUR

T1 - Effect of blood pressure variability during the acute period of subarachnoid hemorrhage on functional outcomes

AU - Ascanio, Luis C.

AU - Enriquez-Marulanda, Alejandro

AU - Maragkos, Georgios A.

AU - Salem, Mohamed M.

AU - Alturki, Abdulrahman Y.

AU - Ravindran, Krishnan

AU - Fehnel, Corey R.

AU - Hanafy, Khalid

AU - Ogilvy, Christopher S.

AU - Thomas, Ajith J.

AU - Moore, Justin M.

N1 - Publisher Copyright: Copyright © 2019 by the Congress of Neurological Surgeons.

PY - 2020/10/1

Y1 - 2020/10/1

N2 - Background: The association of blood pressure variation with poor outcomes in aneurysmal subarachnoid hemorrhage (aSAH) is unknown. Objective: To evaluate the association of systolic blood pressure (SBP) variation and clinical outcomes in aSAH. Methods: We conducted a retrospective chart review of all aSAH patients treated at an academic institution between 2007 and 2016. Patient demographics, aSAH characteristics, and blood pressure observations for the first 24 h of admission in 4-h intervals were obtained. SBP variabilitymetrics assessedweremean, standard deviation, maximum, minimum, peak, trough, coefficient of variation, and successive variation. The primary outcome was a composite of the modified Rankin scale as good (0-2) or poor (3-6) at last follow-up. Comparisons between outcome groups were performed. Logistic regression models for each significant SBP metric controlling for potential confounders were constructed. Results: The study population was 202 patients. The mean age was 57 yr; 66% were female. The median follow-up time was 18 mo; 57 (29%) patients had a poor outcome. Patients with poor outcomes had higher standard deviation (17.1 vs 14.7 mmHg, P = .01), peak (23.5 vs 20.0mmHg, P=.02), trough (22.6 vs 19.2mmHg, P<.01), coefficient of variation (13.9 vs 11.8 mmHg, P < .01), and lower minimum SBP (101.4 vs 108.4, P < .01). The logistic regression showed that every 1-mmHg increase in the minimum SBP increased the odds of good outcomes (odds ratio = 1.03; 95% CI = 1.001-1.064; P = .04). Models including other SBP metrics were not significant. Conclusion: Hypotension was found to be independently associated with poor outcomes in patients with aSAH.

AB - Background: The association of blood pressure variation with poor outcomes in aneurysmal subarachnoid hemorrhage (aSAH) is unknown. Objective: To evaluate the association of systolic blood pressure (SBP) variation and clinical outcomes in aSAH. Methods: We conducted a retrospective chart review of all aSAH patients treated at an academic institution between 2007 and 2016. Patient demographics, aSAH characteristics, and blood pressure observations for the first 24 h of admission in 4-h intervals were obtained. SBP variabilitymetrics assessedweremean, standard deviation, maximum, minimum, peak, trough, coefficient of variation, and successive variation. The primary outcome was a composite of the modified Rankin scale as good (0-2) or poor (3-6) at last follow-up. Comparisons between outcome groups were performed. Logistic regression models for each significant SBP metric controlling for potential confounders were constructed. Results: The study population was 202 patients. The mean age was 57 yr; 66% were female. The median follow-up time was 18 mo; 57 (29%) patients had a poor outcome. Patients with poor outcomes had higher standard deviation (17.1 vs 14.7 mmHg, P = .01), peak (23.5 vs 20.0mmHg, P=.02), trough (22.6 vs 19.2mmHg, P<.01), coefficient of variation (13.9 vs 11.8 mmHg, P < .01), and lower minimum SBP (101.4 vs 108.4, P < .01). The logistic regression showed that every 1-mmHg increase in the minimum SBP increased the odds of good outcomes (odds ratio = 1.03; 95% CI = 1.001-1.064; P = .04). Models including other SBP metrics were not significant. Conclusion: Hypotension was found to be independently associated with poor outcomes in patients with aSAH.

UR - https://www.scopus.com/pages/publications/85091126468

UR - https://www.scopus.com/pages/publications/85091126468#tab=citedBy

U2 - 10.1093/neuros/nyaa019

DO - 10.1093/neuros/nyaa019

M3 - Article

C2 - 32078677

SN - 0148-396X

VL - 87

SP - 779

EP - 787

JO - Neurosurgery

JF - Neurosurgery

IS - 4

ER -