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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Samenvatting

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.

Originele taal-2English
Artikelnummer154124
TijdschriftJournal of Critical Care
Volume72
DOI's
StatusPublished - dec 2022

Bibliografische nota

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.

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