Blood pressure and the risk of rebleeding and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

Celine S Gathier; IJsbrand A J Zijlstra; Gabriel J E Rinkel; T Katrien J Groenhof; Dagmar Verbaan; Bert A Coert; Marcella C A Müller; Walter M van den Bergh; Arjen J C Slooter; Marinus J C Eijkemans

doi:10.1016/j.jcrc.2022.154124

Blood pressure and the risk of rebleeding and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

Celine S Gathier, IJsbrand A J Zijlstra, Gabriel J E Rinkel, T Katrien J Groenhof, Dagmar Verbaan, Bert A Coert, Marcella C A Müller, Walter M van den Bergh, Arjen J C Slooter, Marinus J C Eijkemans

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Abstract

INTRODUCTION AND OBJECTIVE: Blood pressure is presumably related to rebleeding and delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (aSAH) and could serve as a target to improve outcome. We assessed the associations between blood pressure and rebleeding or DCI in aSAH-patients.

MATERIALS AND METHODS: In this observational study in 1167 aSAH-patients admitted to the intensive care unit (ICU), adjusted hazard ratio's (aHR) were calculated for the time-dependent association of blood pressure and rebleeding or DCI. The aHRs were presented graphically, relative to a reference mean arterial pressure (MAP) of 100 mmHg and systolic blood pressure (sBP) of 150 mmHg.

RESULTS: A MAP below 100 mmHg in the 6, 3 and 1 h before each moment in time was associated with a decreased risk of rebleeding (e.g. within 6 h preceding rebleeding: MAP = 80 mmHg: aHR 0.30 (95% confidence interval (CI) 0.11-0.80)). A MAP below 60 mmHg in the 24 h before each moment in time was associated with an increased risk of DCI (e.g. MAP = 50 mmHg: aHR 2.59 (95% CI 1.12-5.96)).

CONCLUSIONS: Our results suggest that a MAP below 100 mmHg is associated with decreased risk of rebleeding, and a MAP below 60 mmHg with increased risk of DCI.

Original language	English
Article number	154124
Journal	Journal of Critical Care
Volume	72
DOIs	https://doi.org/10.1016/j.jcrc.2022.154124
Publication status	Published - Dec 2022

Bibliographical note

Funding Information:
C.S. Gathier was supported by a grant from the Dutch Heart Foundation (grant 2009B046) and the Netherlands Brain Foundation (grant 2009(1)-72).

Publisher Copyright:
© 2022 The Authors

Copyright:
Copyright 2023 Elsevier B.V., All rights reserved.

Keywords

Humans
Subarachnoid Hemorrhage/complications
Blood Pressure
Brain Ischemia/complications
Cerebral Infarction
Intensive Care Units

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Gathier, C. S., Zijlstra, IJ. A. J., Rinkel, G. J. E., Groenhof, T. K. J., Verbaan, D., Coert, B. A., Müller, M. C. A., van den Bergh, W. M., Slooter, A. J. C., & Eijkemans, M. J. C. (2022). Blood pressure and the risk of rebleeding and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Journal of Critical Care, 72, [154124]. https://doi.org/10.1016/j.jcrc.2022.154124

Gathier, Celine S ; Zijlstra, IJsbrand A J ; Rinkel, Gabriel J E ; Groenhof, T Katrien J ; Verbaan, Dagmar ; Coert, Bert A ; Müller, Marcella C A ; van den Bergh, Walter M ; Slooter, Arjen J C ; Eijkemans, Marinus J C. / Blood pressure and the risk of rebleeding and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. In: Journal of Critical Care. 2022 ; Vol. 72.

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title = "Blood pressure and the risk of rebleeding and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage",

abstract = "INTRODUCTION AND OBJECTIVE: Blood pressure is presumably related to rebleeding and delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (aSAH) and could serve as a target to improve outcome. We assessed the associations between blood pressure and rebleeding or DCI in aSAH-patients.MATERIALS AND METHODS: In this observational study in 1167 aSAH-patients admitted to the intensive care unit (ICU), adjusted hazard ratio's (aHR) were calculated for the time-dependent association of blood pressure and rebleeding or DCI. The aHRs were presented graphically, relative to a reference mean arterial pressure (MAP) of 100 mmHg and systolic blood pressure (sBP) of 150 mmHg.RESULTS: A MAP below 100 mmHg in the 6, 3 and 1 h before each moment in time was associated with a decreased risk of rebleeding (e.g. within 6 h preceding rebleeding: MAP = 80 mmHg: aHR 0.30 (95% confidence interval (CI) 0.11-0.80)). A MAP below 60 mmHg in the 24 h before each moment in time was associated with an increased risk of DCI (e.g. MAP = 50 mmHg: aHR 2.59 (95% CI 1.12-5.96)).CONCLUSIONS: Our results suggest that a MAP below 100 mmHg is associated with decreased risk of rebleeding, and a MAP below 60 mmHg with increased risk of DCI.",

keywords = "Humans, Subarachnoid Hemorrhage/complications, Blood Pressure, Brain Ischemia/complications, Cerebral Infarction, Intensive Care Units",

author = "Gathier, {Celine S} and Zijlstra, {IJsbrand A J} and Rinkel, {Gabriel J E} and Groenhof, {T Katrien J} and Dagmar Verbaan and Coert, {Bert A} and M{\"u}ller, {Marcella C A} and {van den Bergh}, {Walter M} and Slooter, {Arjen J C} and Eijkemans, {Marinus J C}",

note = "Funding Information: C.S. Gathier was supported by a grant from the Dutch Heart Foundation (grant 2009B046) and the Netherlands Brain Foundation (grant 2009(1)-72). Publisher Copyright: {\textcopyright} 2022 The Authors Copyright: Copyright 2023 Elsevier B.V., All rights reserved.",

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doi = "10.1016/j.jcrc.2022.154124",

language = "English",

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journal = "Journal of Critical Care",

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Blood pressure and the risk of rebleeding and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. / Gathier, Celine S; Zijlstra, IJsbrand A J; Rinkel, Gabriel J E; Groenhof, T Katrien J; Verbaan, Dagmar; Coert, Bert A; Müller, Marcella C A; van den Bergh, Walter M; Slooter, Arjen J C; Eijkemans, Marinus J C.

In: Journal of Critical Care, Vol. 72, 154124, 12.2022.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Blood pressure and the risk of rebleeding and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

AU - Gathier, Celine S

AU - Zijlstra, IJsbrand A J

AU - Rinkel, Gabriel J E

AU - Groenhof, T Katrien J

AU - Verbaan, Dagmar

AU - Coert, Bert A

AU - Müller, Marcella C A

AU - van den Bergh, Walter M

AU - Slooter, Arjen J C

AU - Eijkemans, Marinus J C

N1 - Funding Information: C.S. Gathier was supported by a grant from the Dutch Heart Foundation (grant 2009B046) and the Netherlands Brain Foundation (grant 2009(1)-72). Publisher Copyright: © 2022 The Authors Copyright: Copyright 2023 Elsevier B.V., All rights reserved.

PY - 2022/12

Y1 - 2022/12

N2 - INTRODUCTION AND OBJECTIVE: Blood pressure is presumably related to rebleeding and delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (aSAH) and could serve as a target to improve outcome. We assessed the associations between blood pressure and rebleeding or DCI in aSAH-patients.MATERIALS AND METHODS: In this observational study in 1167 aSAH-patients admitted to the intensive care unit (ICU), adjusted hazard ratio's (aHR) were calculated for the time-dependent association of blood pressure and rebleeding or DCI. The aHRs were presented graphically, relative to a reference mean arterial pressure (MAP) of 100 mmHg and systolic blood pressure (sBP) of 150 mmHg.RESULTS: A MAP below 100 mmHg in the 6, 3 and 1 h before each moment in time was associated with a decreased risk of rebleeding (e.g. within 6 h preceding rebleeding: MAP = 80 mmHg: aHR 0.30 (95% confidence interval (CI) 0.11-0.80)). A MAP below 60 mmHg in the 24 h before each moment in time was associated with an increased risk of DCI (e.g. MAP = 50 mmHg: aHR 2.59 (95% CI 1.12-5.96)).CONCLUSIONS: Our results suggest that a MAP below 100 mmHg is associated with decreased risk of rebleeding, and a MAP below 60 mmHg with increased risk of DCI.

AB - INTRODUCTION AND OBJECTIVE: Blood pressure is presumably related to rebleeding and delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (aSAH) and could serve as a target to improve outcome. We assessed the associations between blood pressure and rebleeding or DCI in aSAH-patients.MATERIALS AND METHODS: In this observational study in 1167 aSAH-patients admitted to the intensive care unit (ICU), adjusted hazard ratio's (aHR) were calculated for the time-dependent association of blood pressure and rebleeding or DCI. The aHRs were presented graphically, relative to a reference mean arterial pressure (MAP) of 100 mmHg and systolic blood pressure (sBP) of 150 mmHg.RESULTS: A MAP below 100 mmHg in the 6, 3 and 1 h before each moment in time was associated with a decreased risk of rebleeding (e.g. within 6 h preceding rebleeding: MAP = 80 mmHg: aHR 0.30 (95% confidence interval (CI) 0.11-0.80)). A MAP below 60 mmHg in the 24 h before each moment in time was associated with an increased risk of DCI (e.g. MAP = 50 mmHg: aHR 2.59 (95% CI 1.12-5.96)).CONCLUSIONS: Our results suggest that a MAP below 100 mmHg is associated with decreased risk of rebleeding, and a MAP below 60 mmHg with increased risk of DCI.

KW - Humans

KW - Subarachnoid Hemorrhage/complications

KW - Blood Pressure

KW - Brain Ischemia/complications

KW - Cerebral Infarction

KW - Intensive Care Units

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U2 - 10.1016/j.jcrc.2022.154124

DO - 10.1016/j.jcrc.2022.154124

M3 - Article

C2 - 36208555

VL - 72

JO - Journal of Critical Care

JF - Journal of Critical Care

SN - 0883-9441

M1 - 154124

ER -

Blood pressure and the risk of rebleeding and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

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