Mengel Annerose, Siokas Vasileios, Buesink Rebecca, Roesch Sara, Laichinger Kornelia, Ferizi Redina, Dardiotis Efthimios, Sartor-Pfeiffer Jennifer, Single Constanze, Hauser Till-Karsten, Krumbholz Markus, Ziemann Ulf, Feil Katharina
Department of Neurology and Stroke, Eberhard-Karls University of Tübingen, Tübingen, Germany.
Hertie Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany.
Neurocrit Care. 2024 Oct 25. doi: 10.1007/s12028-024-02146-4.
Management of intracerebral hemorrhage (ICH) is challenged by limited therapeutic options and a complex relationship between blood pressure (BP) dynamics, especially BP variability (BPV) and ICH outcome.
In an exploratory analysis of prospectively collected data on consecutive patients with nontraumatic ICH between 2015 and 2020, continuous BP accessed via an arterial line extracted from the Intellispace Critical Care and Anesthesia information system (Philips Healthcare) was analyzed over the first 72 h post admission. Arterial lines were used as part of standard clinical practice in the intensive care, ensuring high fidelity and real-time data essential for acute care settings. BPV was assessed through successive variation (SV), standard deviation (SD), and coefficient of variation using all available BP measurements. Multivariate regression models were applied to evaluate the association between BPV indices and functional outcome at 3 months.
Among 261 patients (mean age 69.6 ± 15.2 years, 47.9% female, median National Institutes of Health Stroke Scale [NIHSS] score 6 [interquartile range 2-12]) analyzed, lower systolic BP upon admission (< 140 mm Hg) and lower systolic BPV were significantly associated with favorable outcome, whereas higher diastolic BPV correlated with improved outcomes. In the multivariate analysis, diastolic BPV (SD, SV) within the first 72 h post admission emerged as an independent predictor of good functional outcome (modified Rankin Scale score < 3; odds ratio 1.123, 95% confidence interval CI 1.008-1.184, p = 0.035), whereas systolic BPV (SD) showed a negative association. Patients with better outcomes also exhibited distinct clinical characteristics, including younger age, lower median NIHSS scores, and less prevalence of anticoagulation therapy upon admission.
This study shows the prognostic value of BPV in the acute phase of ICH. Lower systolic BPV (SD) and higher diastolic BPV (SD, SV) were associated with better functional outcomes, challenging traditional BP management strategies. These findings might help to tailor a personalized BP management in ICH.
脑出血（ICH）的治疗面临挑战，因为治疗选择有限，且血压（BP）动态变化之间存在复杂关系，尤其是血压变异性（BPV）与ICH预后之间的关系。
在对2015年至2020年间连续收治的非创伤性ICH患者的前瞻性收集数据进行的探索性分析中，对入院后最初72小时内通过从Intellispace重症监护和麻醉信息系统（飞利浦医疗保健公司）提取的动脉导管获取的连续血压进行了分析。动脉导管作为重症监护标准临床实践的一部分使用，确保了急性护理环境所需的高保真度和实时数据。使用所有可用的血压测量值，通过逐次变化（SV）、标准差（SD）和变异系数评估BPV。应用多变量回归模型评估BPV指数与3个月时功能结局之间的关联。
在分析的261例患者（平均年龄69.6±15.2岁，47.9%为女性，美国国立卫生研究院卒中量表[NIHSS]中位数评分6[四分位间距2-12]）中，入院时较低的收缩压（<140 mmHg）和较低的收缩压变异性与良好结局显著相关，而较高的舒张压变异性与较好结局相关。在多变量分析中，入院后最初72小时内的舒张压变异性（SD，SV）成为良好功能结局（改良Rankin量表评分<3；比值比1.123，95%置信区间CI 1.008-1.184，p=0.035）的独立预测因素，而收缩压变异性（SD）显示出负相关。结局较好的患者还表现出不同的临床特征，包括年龄较小、NIHSS中位数评分较低以及入院时抗凝治疗的患病率较低。
本研究显示了BPV在ICH急性期的预后价值。较低的收缩压变异性（SD）和较高的舒张压变异性（SD，SV）与较好的功能结局相关，这对传统的血压管理策略提出了挑战。这些发现可能有助于为ICH制定个性化的血压管理方案。
