Initial intracranial pressure is an independent predictor of unfavorable functional outcomes after aneurysmal subarachnoid hemorrhage

Joshua A Cuoco; Evin L Guilliams; John J Entwistle; Biraj M Patel; Eric A Marvin

doi:10.1016/j.jocn.2021.10.003

Initial intracranial pressure is an independent predictor of unfavorable functional outcomes after aneurysmal subarachnoid hemorrhage

J Clin Neurosci. 2021 Dec:94:152-158. doi: 10.1016/j.jocn.2021.10.003. Epub 2021 Oct 26.

Authors

Joshua A Cuoco¹, Evin L Guilliams², John J Entwistle³, Biraj M Patel⁴, Eric A Marvin⁵

Affiliations

¹ Section of Neurosurgery, Carilion Clinic, 1906 Belleview Avenue, Roanoke, VA 24014, USA; Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, USA; School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA. Electronic address: [email protected].
² Section of Neurosurgery, Carilion Clinic, 1906 Belleview Avenue, Roanoke, VA 24014, USA; Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, USA; School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA. Electronic address: [email protected].
³ Section of Neurosurgery, Carilion Clinic, 1906 Belleview Avenue, Roanoke, VA 24014, USA; Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, USA; School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA. Electronic address: [email protected].
⁴ Section of Neurosurgery, Carilion Clinic, 1906 Belleview Avenue, Roanoke, VA 24014, USA; Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, USA; School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA; Neurointerventional Surgery, Department of Radiology, Carilion Clinic, 1906 Belleview Avenue, Roanoke, VA 24014, USA. Electronic address: [email protected].
⁵ Section of Neurosurgery, Carilion Clinic, 1906 Belleview Avenue, Roanoke, VA 24014, USA; Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, USA; School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA. Electronic address: [email protected].

PMID: 34863430
DOI: 10.1016/j.jocn.2021.10.003

Abstract

The authors sought to evaluate whether initial intracranial pressure was associated with functional outcomes following aneurysmal subarachnoid hemorrhage. This retrospective analysis consisted of 54 consecutive patients with aneurysmal subarachnoid hemorrhage and acute symptomatic hydrocephalus requiring emergent placement of an external ventricular drain. Patient demographics, clinical data, intracranial pressure parameters, and radiographic imaging were collected. Functional outcomes were evaluated at 3 months using the modified Rankin Scale and dichotomized as favorable (modified Rankin Scale 0-2) or unfavorable (modified Rankin Scale 3-6). Univariate and multivariate logistic regression analyses were performed to investigate parameters independently associated with functional outcomes. In an adjusted multivariate logistic regression model, initial intracranial pressure (OR: 1.371, 95% CI: 1.119-1.679; p = 0.002) was found to be an independent predictor of unfavorable functional outcomes at 3 months. Receiver operating characteristic curve analysis for the prediction of unfavorable functional outcomes demonstrated that initial intracranial pressure exhibited an acceptable area under the curve (AUC = 0.901, 95% CI: 0.818-0.985; p < 0.001). The optimal predictive threshold to distinguish between favorable and unfavorable functional outcomes was identified at an initial intracranial pressure of 25 mmHg.

Keywords: Aneurysm; Aneurysmal subarachnoid hemorrhage; Functional outcomes; Hydrocephalus; Intracranial pressure.

MeSH terms

Humans
Hydrocephalus*
Intracranial Pressure
ROC Curve
Retrospective Studies
Subarachnoid Hemorrhage* / diagnostic imaging