Song Xindi, Wang Yanan, Guo Wen, Liu Meng, Deng Yilun, Ye Kaili, Liu Ming
Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China.
Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China.
Diagnostics (Basel). 2023 Jul 27;13(15):2506. doi: 10.3390/diagnostics13152506.
Large hemispheric infarction (LHI) can lead to fatal complications such as malignant brain edema (MBE). We aimed to investigate the correlation between heart-rate-to-blood-pressure ratios and MBE or one-month death after LHI.
We prospectively included LHI patients from a registered cohort. Hourly heart-rate-to-blood-pressure ratios were recorded as a variation of the traditional shock index (SI), SI and SI (systolic and diastolic pressures, respectively), and calculated for mean and variability (standard deviation) in 24 h and two 12 h epochs (1-12 h and 13-24 h) after onset of symptoms. MBE was defined as neurological deterioration symptoms with imaging evidence of brain swelling. We employed a generalized estimating equation to compare the trend in longitudinal collected SI and SI between patients with and without MBE. We used multivariate logistic regression to investigate the correlation between SI, SI and outcomes.
Of the included 162 LHI patients, 28.4% (46/162) developed MBE and 25.3% (40/158) died within one month. SI and SI increased over baseline in all patients, with a similar ascending profile during the first 12 h epoch and a more intensive increase in the MBE group during the second 12 h epoch ( < 0.05). During the overall 24 h, patients with greater SI variability had a significantly increased MBE risk after adjustment (OR 3.72, 95%CI 1.38-10.04). Additionally, during the second 12 h epoch (13-24 h after symptom onset), patients developing MBE had a significantly higher SI level (OR 1.18, 95%CI 1.00-1.39) and greater SI variability (OR 3.16, 95%CI 1.35-7.40). Higher SI and greater SI variability within 24 h independently correlated with one-month death (all < 0.05). Within the second 12 h epoch, higher SI, higher SI and greater SI variability independently correlated with one-month death (all < 0.05). No significant correlation was observed in the first 12 h epoch.
Higher and more fluctuated heart-rate-to-blood-pressure ratios independently correlated with MBE development and one-month death in LHI patients, especially during the second 12 h (13-24 h) epoch after onset.
大面积半球梗死（LHI）可导致恶性脑水肿（MBE）等致命并发症。我们旨在研究心率与血压比值与LHI后MBE或1个月死亡率之间的相关性。
我们前瞻性纳入了一个登记队列中的LHI患者。每小时记录心率与血压比值，作为传统休克指数（SI）、SI（分别为收缩压和舒张压）的变化，并计算症状发作后24小时以及两个12小时时段（1 - 12小时和13 - 24小时）的平均值和变异性（标准差）。MBE定义为具有脑肿胀影像学证据的神经功能恶化症状。我们采用广义估计方程比较有和无MBE患者纵向收集的SI和SI的趋势。我们使用多因素逻辑回归研究SI、SI与结局之间的相关性。
纳入的162例LHI患者中，28.4%（46/162）发生了MBE，25.3%（40/158）在1个月内死亡。所有患者的SI和SI均高于基线水平，在第一个12小时时段内上升趋势相似，而在第二个12小时时段内MBE组上升更为剧烈（<0.05）。在整个24小时内，调整后SI变异性较大的患者发生MBE的风险显著增加（OR 3.72，95%CI 1.38 - 10.04）。此外，在第二个12小时时段（症状发作后13 - 24小时），发生MBE的患者SI水平显著更高（OR 1.18，95%CI 1.00 - 1.39）且SI变异性更大（OR 3.16，95%CI 1.35 - 7.40）。24小时内较高的SI和较大的SI变异性与1个月死亡率独立相关（均<0.05）。在第二个12小时时段内，较高的SI、较高的SI和较大的SI变异性与1个月死亡率独立相关（均<0.05）。在第一个12小时时段未观察到显著相关性。
较高且波动较大的心率与血压比值与LHI患者MBE的发生和1个月死亡率独立相关，尤其是在发病后的第二个12小时（13 - 24小时）时段。
