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Journal of Neurosurgical Sciences 2021 Oct 14

DOI: 10.23736/S0390-5616.21.05477-1


lingua: Inglese

Blood pressure variability and prognosis in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

Subhas KONAR 1, William FLOREZ-PERDOMO 2, 3, Ezequiel GARCIA-BALLESTAS 2, 3, Gabriel A. QUIÑONES-OSSA 2, 4 , Tariq JANJUA 5, Luis R. MOSCOTE-SALAZAR 2, 3, Rakesh K. MISHRA 6, Amit AGRAWAL 6

1 Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India; 2 Consejo Latinoamericano de Cuidado Neurocrítico - CLaNi, Cartagena, Colombia; 3 Centro De Investigaciones Biomédicas (CIB); Faculty of Medicine - University of Cartagena, Cartagena, Colombia; 4 Faculty of Medicine, Universidad El Bosque, Bogotá, Colombia; 5 Regions Hospital, Saint Paul, MN, USA; 6 Department of Neurosurgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal, India

INTRODUCTION: The subarachnoid hemorrhage due to a ruptured brain aneurysm is a neurological emergency with high mobility and mortality. Hypertensive states are related to a bad prognosis and a higher risk of a ruptured aneurysm. However, the relationship between the blood pressure variability with the aneurysmal subarachnoid hemorrhage and its prognosis is quite unknown.
EVIDENCE ACQUISITION: A systematic review was performed across the databases. The following descriptors and related were used for the search: “blood pressure”, “arterial pressure”, variability, subarachnoid hemorrhage, hemorrhage, aneurysmal, aneurysmal subarachnoid hemorrhage. The following data were extracted: Glasgow Outcome Scale or Modified Rankin Scale, and blood pressure variabilities to categorize the prognosis.
EVIDENCE SYNTHESIS: 5 studies were selected. The blood pressure variability and the related outcome were assessed by mean systolic blood pressure and minimum systolic blood. The meta-analysis of mean systolic blood pressure (cut-off >95.3 mmHg) showed an odds ratio of 11.23 (CI 95%: 4,423 to 28,537) (p=<0.001), predicting the good outcome after the aneurysmal subarachnoid hemorrhage. The pooled analysis revealed AUC of the ROC predicting the good outcome was statistically significant (AUC:0.85, p<0.001). The pooled data analysis of minimum systolic blood pressure revealed an odds ratio of 6.43 (CI 95%:2.834-14.589, P <0,001) and AUC of the pooled ROC 0.931 (CI95%:0,851 to 1,000, P <0,001) to predict poor outcome. The funnel plot through Egger’s test for the analysis showed different grades of asymmetry.
CONCLUSIONS: The blood pressure variability (mean and minimum systolic blood pressure) is a good predictor and parameter in the aneurysmal subarachnoid hemorrhage prognosis and outcome prediction.

KEY WORDS: Intracranial aneurysms; Intracranial hemorrhage; Blood pressure; Hypertension; Systolic blood pressure

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