Anesth Pain Med.  2024 Oct;19(4):302-309. 10.17085/apm.24039.

Overall and linked blood pressure variabilities in the first 24 hours and mortality after spontaneous intracerebral hemorrhage: a retrospective study of 1,036 patients

• Cho H
• Kim T
• Lee Y
• Kim D
• Bae H

• KMID: 2563572
• DOI: http://doi.org/10.17085/apm.24039

Abstract

Background
This study aims to establish the individual contributions of blood pressure variability (BPV) indexes, categorized into overall and linked variability, to mortality following intracerebral hemorrhage (ICH) by examining the risk factors. Methods: Patients with spontaneous ICH (n = 1,036) were identified with valid blood pressures (BP) from the first 24-h systolic BP records in the Medical Information Mart for Intensive Care IV version 2.2 database (MIMIC IV). Information on the baseline characteristics, including age, sex, initial Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) scores, ICH location, Charlson comorbidity index score, and presence of diabetes with or without complications, were collected. Three indexes of BPV—range, standard deviation (SD), and generalized BPV (GBPV)—were calculated using the first 24-h systolic BPs. An automated stepwise variable-selection procedure was used to develop the final logistic model for predicting in-hospital mortality. Results: Out of 1,036 patients, 802 (77.4%) survived and were discharged after spontaneous ICH. Factors associated with mortality included age; male sex; ICH in the brainstem, ventricle, or multiple locations; low GCS score (< 9); high NIHSS score (> 20); and diabetes with complications. Mean systolic BP, SD, and GBPV were also linked to mortality. Higher GBPV notably increased the risk of in-hospital death, with an odds ratio of 3.21 (95% confidence interval, 2.10 to 4.97) for every + 10 mmHg/h change in GBPV. Conclusions: This study underscores the additional impact of GBPV, herein linked to BPV, on mortality following ICH, providing further insights into the management of blood pressure in the early stages of ICH treatment.

Keyword

Intracerebral hemorrhage; Blood pressure; Blood pressure variability; Intensive care; Mortality; Prognosis

Figure

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  Fig. 1. Summary plots for four SBP derivatives: (A) mean systolic BP, (B) range of SBP, (C) standard deviation of SBP, and (D) generalized BP variability. Each boxplot includes a box (Q1 and Q3), a median line (Q2), whiskers (lines extending to the farthest points within +/- 1.5 times the interquartile range from the box's edges), and outliers. Note that the Y-axis of subplot (D) is transformed using the common logarithm. SBP: systolic blood pressure, GBPV: generalized blood pressure variability.

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