Intracranial Pressure Monitoring-Aided Management Associated with Favorable Outcomes in Patients with Hypertension-Relat
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ORIGINAL ARTICLE
Intracranial Pressure Monitoring-Aided Management Associated with Favorable Outcomes in Patients with Hypertension-Related Spontaneous Intracerebral Hemorrhage Junwei Ren 1 & Xing Wu 1 & Jiongwei Huang 1 & Xudong Cao 2 & Qiang Yuan 1 & Dalong Zhang 3 & Zhuoying Du 1 & Ping Zhong 1 & Jin Hu 1 Received: 28 August 2019 / Revised: 23 February 2020 / Accepted: 26 February 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract To investigate the effect of intracranial pressure (ICP) monitoring on the functional outcome of patients with hypertension-related spontaneous intracerebral hemorrhage (ICH). We included 196 patients with Glasgow Coma Scale (GCS) scores of 3–12 in this observational study, of which 103 underwent ICP monitors. Binary and ordinal regression analyses were used to estimate the effect of ICP monitoring on the functional outcome. The rate of adverse events, blood pressure control, and length of hospitalization were compared between the two groups. ICP monitoring had a significant impact on the clinical outcome of patients by shifting the Extended Glasgow Outcome Scale (GOS-E) scores in a favorable direction (p = 0.027) and reducing mortality at discharge (p = 0.004) and 6 months later (p = 0.02). The rate of favorable outcome at 6 months was higher in the ICP-monitored group (p = 0.03). However, subgroup analysis showed that no relationship between ICP monitoring and clinical outcome was found for patients with GCS scores of 3–8. For patients with GCS scores of 9–12, the distribution of GOS-E scores at 6 months shifted in a favorable direction in the ICP-monitored group (p = 0.001). The rate of favorable outcome at 6 months was higher in the ICP-monitored group (p = 0.01). The mortality at discharge and 6 months later was also lower in the ICP-monitored group. Thus, our study supports the value of ICP monitoring in hypertension-related ICH patients with GCS scores of 3–12, especially those with GCS scores of 9–12. Keywords Intracerebral hemorrhage . Intracranial pressure monitoring . Hypertension . Outcome
Introduction Spontaneous intracerebral hemorrhage (ICH), which is the least treatable form of stroke, affects more than 1 million Junwei Ren, Xing Wu, Jiongwei Huang, Xudong Cao and Qiang Yuan contributed equally to this work. * Ping Zhong [email protected] * Jin Hu [email protected] 1
Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
2
Department of Neurosurgery, Tibet Autonomous Region People’s Hospital, Lhasa, Tibet, China
3
Department of Emergency, The First Affiliated Hospital of Soochow University, Suzhou, China
people annually worldwide [1, 2]. Nearly one-third of stroke cases are caused by ICH [3], and 60–70% are due to hypertension-related ICH [4, 5]. However, no interventions have been demonstrated to improve outcomes of ICH patients [2, 6, 7]. Elevated intracranial pressure (ICP) is a common complication of spontaneous ICH, mainly caused by the mass effect of hematoma, peripheral cerebral edema, and obstructive
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