Association of pulse pressure with hematoma expansion in patients with spontaneous supratentorial intracerebral hemorrhage

Chao-Ying Wang, Su-Zhen Lai, Bao-Cai Kang, Yi-Zhao Lin, Chun-Juan Cao, Xin-Bing Huang, Jian-Qun Wang
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Abstract

Recent reports have demonstrated that a wider pulse pressure upon admission is correlated with heightened in-hospital mortality following spontaneous supratentorial intracerebral hemorrhage (ssICH). However, the underlying mechanism remains ambiguous. We investigated whether a wider pulse pressure was associated with hematoma expansion (HE).Demographic information, clinical features, and functional outcomes of patients diagnosed with ssICH were retrospectively collected and analyzed. Multivariate logistic regression was conducted to identify independent predictors of HE. Weighted logistic regression, restricted cubic spline models, and propensity score matching (PSM) were employed to estimate the association between pulse pressure and HE.We included 234 eligible adult ssICH patients aged 60 (51–71) years, and 55.56% were male. The mean pulse pressure was 80.94 ± 23.32 mmHg. Twenty-seven patients (11.54%) developed early HE events, and 116 (49.57%) experienced a poor outcome (modified Rankin scale 3–6). A wider mean pulse pressure as a continuous variable was a predictor of HE [odds ratios (OR) 1.026, 95% confidence interval (CI) 1.007–1.046, p = 0.008] in multivariate analysis. We transformed pulse pressure into a dichotomous variable based on its cutoff value. After adjusting for confounding of HE variables, the occurrence of HE in patients with ssICH with wider pulse pressure levels (≥98 mmHg) had 3.78 times (OR 95% CI 1.47–9.68, p = 0.006) compared to those with narrower pulse pressure levels (<98 mmHg). A linear association was observed between pulse pressure and increased HE risk (P for overall = 0.036, P for nonlinear = 0.759). After 1:1 PSM (pulse pressure ≥98 mmHg vs. pulse pressure <98 mmHg), the rates of HE events and poor outcome still had statistically significant in wider-pulse pressure group [HE, 12/51 (23.53%) vs. 4/51 [7.84%], p = 0.029; poor outcome, 34/51 (66.67%) vs. 19/51 (37.25%), p = 0.003].Widened acute pulse pressure (≥98 mmHg) levels at admission are associated with increased risks of early HE and unfavorable outcomes in patients with ssICH.
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脉压与自发性颅内出血患者血肿扩大的关系
最近的报告表明,入院时脉压增大与自发性颅内出血(ssICH)的院内死亡率增高有关。然而,其潜在机制仍不明确。我们研究了较宽的脉压是否与血肿扩大(HE)有关。我们回顾性地收集并分析了确诊为 ssICH 患者的人口统计学信息、临床特征和功能预后。研究人员回顾性分析了被诊断为 ssICH 的患者的人口统计学信息、临床特征和功能预后,并进行了多变量逻辑回归以确定 HE 的独立预测因素。我们纳入了234名符合条件的成年ssICH患者,年龄在60(51-71)岁之间,其中55.56%为男性。平均脉压为 80.94 ± 23.32 mmHg。27名患者(11.54%)发生了早期高血压事件,116名患者(49.57%)的预后不佳(改良Rankin量表3-6)。在多变量分析中,作为连续变量的平均脉压越宽越能预测 HE [几率比 (OR) 1.026,95% 置信区间 (CI) 1.007-1.046,P = 0.008]。我们根据脉压的临界值将其转化为二分变量。在调整了 HE 变量的混杂因素后,脉压水平较宽(≥98 mmHg)的 ssICH 患者的 HE 发生率是脉压水平较窄(<98 mmHg)患者的 3.78 倍(OR 95% CI 1.47-9.68,p = 0.006)。脉压与 HE 风险增加之间存在线性关系(总体 P = 0.036,非线性 P = 0.759)。经过 1:1 PSM(脉压≥98 mmHg vs. 脉压<98 mmHg)后,脉压较宽组的 HE 事件发生率和不良预后率仍具有显著的统计学意义 [HE, 12/51 (23.53%) vs. 4/51 [7.84%],P = 0.入院时急性脉压增宽(≥98 mmHg)与 ssICH 患者早期 HE 风险增加和不良预后有关。
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