Title:Duration of Intracranial Pressure Increase after Aneurysmal Subarachnoid Hemorrhage: Prognostic Factors and Association with the Outcome
Volume: 21
Issue: 3
Author(s): Pikria Ketelauri*, Meltem Gümüs, Hanah Hadice Gull, Maryam Said, Laurel Rauschenbach, Thiemo Florin Dinger, Mehdi Chihi, Marvin Darkwah Oppong, Yahya Ahmadipour, Philipp Dammann, Karsten Henning Wrede, Ulrich Sure and Ramazan Jabbarli
Affiliation:
- Department of Neurosurgery and Spine Surgery, Essen University Hospital, Hufelandstrasse 55, Essen, 45147, Germany
Keywords:
Aneurysmal subarachnoid hemorrhage, intracranial pressure increase, prognostic factors, cerebral infarction, aneurysm rupture, prognosis
Abstract:
Objective: A rupture of the intracranial aneurysm is frequently complicated, with an
increase of intracranial pressure (ICP) requiring conservative and/or surgical treatment. We analyzed
the risk factors related to the duration of pathologic ICP increase and the relationship between
ICP burden and the outcome of subarachnoid hemorrhage (SAH).
Methods: Consecutive cases with aneurysmal SAH treated at our institution between 01/2003
and 06/2016 were eligible for this study. Different admission variables were evaluated to predict
the duration of ICP increase >20 mmHg in univariate and multivariate analyses. The association
of the ICP course with SAH outcome parameters (risk of cerebral infarction, in-hospital mortality,
and unfavorable outcome at 6 months defined as modified Rankin scale >3) was adjusted for
major outcome-relevant confounders.
Results: Of 820 SAH patients, 378 individuals (46.1%) developed at least one ICP increase requiring
conservative and/or surgical management after aneurysm treatment (mean duration: 1.76
days, range: 1 - 14 days). In the multivariable linear regression analysis, patients’ age (unstandardized
coefficient [UC]=-0.02, p <0.0001), World Federation of Neurosurgical Societies
(WFNS) grade 4-5 at admission (UC=0.71, p <0.004), regular medication with the angiotensinconverting
enzyme (ACE) inhibitors (UC=-0.61, p =0.01), and presence of intracerebral hemorrhage
(UC=0.59, p =0.002) were associated with the duration of ICP increase. In turn, patients
with longer ICP elevations were at higher risk for cerebral infarction (adjusted odds ratio
[aOR]=1.32 per-day-increase, p <0.0001), in-hospital mortality (aOR=1.30, p <0.0001) and unfavorable
outcome (aOR=1.43, p <0.0001). SAH patients who underwent primary decompressive
craniectomy (DC) showed shorter periods of ICP increase than patients with a secondary
decompression (mean: 2.8 vs 4.9 days, p <0.0001).
Conclusion: The duration of ICP increase after aneurysm rupture is a strong outcome predictor
and is related to younger age and higher initial severity of SAH. Further analysis of the factors
impacting the course of ICP after SAH is essential for the optimization of ICP management and
outcome improvement.
