ICP variability associates with 3-month outcomes in spontaneous intracerebral hemorrhage: a retrospective analysis of 597 patients

Abstract

Abstract Background Invasive intracranial pressure (ICP) monitoring is frequently employed in spontaneous intracerebral hemorrhage (ICH) treatment, but its benefit to ICH patients’ outcomes is debated. ICP variability (IPV) has been linked to poor outcomes in patients with subarachnoid hemorrhage (SAH) and traumatic brain injury (TBI), but this association with outcomes in ICH has yet to be definitively established. We hypothesized that IPV within the initial 72 hours following ICP probe insertion is predictive of outcomes in ICH patient. Methods A retrospective chart review analysis of adult ICH patients, who received ICP monitoring at Huashan Hospital Fudan University between Jan. 2016 and Jan. 2023, was performed. We included ICH patients within 6 hours of signs or symptoms onset. Outcomes of ICH patients were assessed using 3-month mRS, and were dichotomized into poor (mRS 4 to 6) and good (mRS 0 to 3) outcome group. ICPs were recorded from the implantation of invasive ICP probe until it was removed. ICP was analyzed in the acute period, from 0 to 72 hours after ICP implantation. IPV was analyzed by SD (Standard deviation), CV (Coefficient of variation) and SV (Successive variation) of ICP. Results We analyzed 597 patients’ charts. The 1st ICP assessment, immediately after ICP implantation, at median 117 minutes (interquartile range, 82–231 minutes) after admission was mean 20.5 ± 7.8 mmHg. The 2nd ICP assessment, on NICU arrival after operation, was mean 14.6 ± 8.3 mmHg. Poor outcomes occurred in 213 patients (35.68%). In univariate analysis, univariate quintile analysis or multivariate analysis, SBPSD, SBPCV and SBPSV were associated with poor outcomes. Conclusions IPV within the first 72 hours post-ICP probe implantation in ICH patients independently correlates with poor 3-month functional outcome. Stabilization of IPV with initial 72 hours following ICP probe insertion maybe a potential therapeutic target to improve functional outcomes of these patients.