Departments of Neurosurgery, University of Utah, Salt Lake City, UT, USA.
Departments of Neurosurgery, University of Utah, Salt Lake City, UT, USA.
J Stroke Cerebrovasc Dis. 2021 Mar;30(3):105540. doi: 10.1016/j.jstrokecerebrovasdis.2020.105540. Epub 2020 Dec 22.
Intracranial pressure (ICP) monitors have been used in some patients with spontaneous intracranial hemorrhage (ICH) to provide information to guide treatment without clear evidence for its use in this population. We assessed the impact of ICP monitor placement, including external ventricular drains and intraparenchymal monitors, on neurologic outcome in this population.
In this secondary analysis of the Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation III trial, the primary outcome was poor outcome (modified Rankin Scale score 4-6) and the secondary outcome was death, at 1 year from onset. We compared outcomes in patients with or without an ICP monitor using unadjusted and adjusted logistic regression models. The analyses were repeated in a balanced cohort created with propensity score matching.
Seventy patients underwent ICP monitor placement and 424 did not. Poor outcome was seen in 77.1% of patients in the ICP-monitor subgroup compared with 53.8% in the no-monitor subgroup (p<0.001). Of patients in the ICP-monitor subgroup, 31.4% died, compared with 21.0% in the no-monitor subgroup (p=0.053). In multivariate models, ICP monitor placement was associated with a >2-fold greater risk of poor outcome (odds ratio 2.76, 95% CI 1.30-5.85, p=0.008), but not with death (p=0.652). Our findings remained consistent in the propensity score-matched cohort.
These results question whether ICP monitor-guided therapy in patients with spontaneous nontraumatic ICH improves outcome. Further work is required to define the causal pathway and improve identification of patients that might benefit from invasive ICP monitoring.
颅内压（ICP）监测器已在一些自发性颅内出血（ICH）患者中使用，以提供指导治疗的信息，但在该人群中使用的证据尚不明确。我们评估了在该人群中，ICP 监测器（包括外部脑室引流管和脑内监测器）的放置对神经功能结局的影响。
在微创手术加阿替普酶治疗脑出血清除 III 试验的二次分析中，主要结局是不良结局（改良Rankin 量表评分 4-6），次要结局是 1 年时的死亡。我们使用未调整和调整后的逻辑回归模型比较了有和没有 ICP 监测器的患者的结局。分析结果在通过倾向评分匹配创建的平衡队列中重复。
70 例患者接受了 ICP 监测器放置，424 例患者未接受。在 ICP 监测器亚组中，77.1%的患者预后不良，而在无监测器亚组中，53.8%的患者预后不良（p<0.001）。在 ICP 监测器亚组中，31.4%的患者死亡，而在无监测器亚组中，21.0%的患者死亡（p=0.053）。在多变量模型中，ICP 监测器的放置与不良结局的风险增加超过 2 倍相关（优势比 2.76，95%CI 1.30-5.85，p=0.008），但与死亡无关（p=0.652）。我们的发现在倾向评分匹配的队列中仍然一致。
这些结果质疑在自发性非创伤性 ICH 患者中，ICP 监测器指导治疗是否能改善结局。需要进一步的工作来确定因果关系，并改善对可能受益于侵入性 ICP 监测的患者的识别。
