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

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

5 Downloads (Pure)

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
Early online date	5 Oct 2022
DOIs	https://doi.org/10.1016/j.jcrc.2022.154124
Publication status	Published - Dec 2022

Keywords

Aneurysmal subarachnoid hemorrhage
Blood pressure
Delayed cerebral ischemia
Intensive care
Rebleeding

Access to Document

10.1016/j.jcrc.2022.154124Licence: CC BY-NC-ND

1-s2.0-S0883944122001538-mainFinal published version, 1.35 MBLicence: CC BY-NC-ND

Cite this

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, Article 154124. https://doi.org/10.1016/j.jcrc.2022.154124

@article{79a4502997e04317bc2a37222a6596d1,

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 = "Aneurysmal subarachnoid hemorrhage, Blood pressure, Delayed cerebral ischemia, Intensive care, Rebleeding",

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",

year = "2022",

month = dec,

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

language = "English",

volume = "72",

journal = "Journal of Critical Care",

issn = "0883-9441",

publisher = "W.B. Saunders",

}

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

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 - Aneurysmal subarachnoid hemorrhage

KW - Blood pressure

KW - Delayed cerebral ischemia

KW - Intensive care

KW - Rebleeding

UR - https://www.scopus.com/pages/publications/85139335996

U2 - 10.1016/j.jcrc.2022.154124

DO - 10.1016/j.jcrc.2022.154124

M3 - Article

C2 - 36208555

SN - 0883-9441

VL - 72

JO - Journal of Critical Care

JF - Journal of Critical Care

M1 - 154124

ER -

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

Abstract

Keywords

Access to Document

Other files and links

Fingerprint

Cite this