TY - JOUR
T1 - Blood pressure and the risk of rebleeding and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage
AU - Gathier, Celine S.
AU - Zijlstra, I. Jsbrand A. J.
AU - Rinkel, Gabriel J. E.
AU - Groenhof, T. Katrien J.
AU - Verbaan, Dagmar
AU - Coert, Bert A.
AU - Müller, Marcella C. A.
AU - van den Bergh, Walter M.
AU - Slooter, Arjen J. C.
AU - Eijkemans, Marinus J. C.
N1 - Funding Information: C.S. Gathier was supported by a grant from the Dutch Heart Foundation (grant 2009B046) and the Netherlands Brain Foundation (grant 2009(1)-72). Publisher Copyright: © 2022 The Authors
PY - 2022/12/1
Y1 - 2022/12/1
N2 - Introduction and objective: Blood pressure is presumably related to rebleeding and delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (aSAH) and could serve as a target to improve outcome. We assessed the associations between blood pressure and rebleeding or DCI in aSAH-patients. Materials and methods: In this observational study in 1167 aSAH-patients admitted to the intensive care unit (ICU), adjusted hazard ratio's (aHR) were calculated for the time-dependent association of blood pressure and rebleeding or DCI. The aHRs were presented graphically, relative to a reference mean arterial pressure (MAP) of 100 mmHg and systolic blood pressure (sBP) of 150 mmHg. Results: A MAP below 100 mmHg in the 6, 3 and 1 h before each moment in time was associated with a decreased risk of rebleeding (e.g. within 6 h preceding rebleeding: MAP = 80 mmHg: aHR 0.30 (95% confidence interval (CI) 0.11–0.80)). A MAP below 60 mmHg in the 24 h before each moment in time was associated with an increased risk of DCI (e.g. MAP = 50 mmHg: aHR 2.59 (95% CI 1.12–5.96)). Conclusions: Our results suggest that a MAP below 100 mmHg is associated with decreased risk of rebleeding, and a MAP below 60 mmHg with increased risk of DCI.
AB - Introduction and objective: Blood pressure is presumably related to rebleeding and delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (aSAH) and could serve as a target to improve outcome. We assessed the associations between blood pressure and rebleeding or DCI in aSAH-patients. Materials and methods: In this observational study in 1167 aSAH-patients admitted to the intensive care unit (ICU), adjusted hazard ratio's (aHR) were calculated for the time-dependent association of blood pressure and rebleeding or DCI. The aHRs were presented graphically, relative to a reference mean arterial pressure (MAP) of 100 mmHg and systolic blood pressure (sBP) of 150 mmHg. Results: A MAP below 100 mmHg in the 6, 3 and 1 h before each moment in time was associated with a decreased risk of rebleeding (e.g. within 6 h preceding rebleeding: MAP = 80 mmHg: aHR 0.30 (95% confidence interval (CI) 0.11–0.80)). A MAP below 60 mmHg in the 24 h before each moment in time was associated with an increased risk of DCI (e.g. MAP = 50 mmHg: aHR 2.59 (95% CI 1.12–5.96)). Conclusions: Our results suggest that a MAP below 100 mmHg is associated with decreased risk of rebleeding, and a MAP below 60 mmHg with increased risk of DCI.
KW - Aneurysmal subarachnoid hemorrhage
KW - Blood pressure
KW - Delayed cerebral ischemia
KW - Intensive care
KW - Rebleeding
UR - http://www.scopus.com/inward/record.url?scp=85139335996&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jcrc.2022.154124
DO - https://doi.org/10.1016/j.jcrc.2022.154124
M3 - Article
C2 - 36208555
SN - 0883-9441
VL - 72
JO - Journal of Critical Care
JF - Journal of Critical Care
M1 - 154124
ER -