Abstract Details

Title The Magnitude of Blood Pressure Reduction in Intracerebral hemorrhage Is Associated with In-Hospital Outcomes

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) Neurocritical Care Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 005

Objective

We aimed to determine the prognostic significance of early magnitude of systolic blood pressure (SBP) reduction (M-SPB-R) in the first 24 hours after intracerebral hemorrhage (ICH).

Background Early SBP reduction may improve the outcome after ICH. However, there has been a limited assessment of M-SPB-R as opposed to target SBP on outcomes in ICH.

Design/Methods

We collected 10 years (2008-2017) of ICH data from two hospital systems. Unsupervised functional principal components analysis (FPCA) was used to characterize the effect of M-SPB-R on the primary outcome defined as discharge modified Rankin scale (mRS) of 0-2, 3-4, and 5-6 defined as good, poor, and severe, respectively. Ordinal logistic regression models adjusted for baseline SBP and ICH volume were used to determine the prognostic significance of M-SPB-R.

Results The 757 patients included in the study were 65±23 years old, 56% were men, with a mean Glasgow coma scale of 14 (IQR). FPCA revealed that an increase in M-SPB-R (per 10 mmHg) was significantly associated with unfavorable outcome defined as mRS>2 (adjusted-OR=1.134; 95% CI: 1.044-1.233, P=0.003). Compared with M-SPB-R <20 mmHg, worse outcomes were observed for M-SPB-R= 40-60 mmHg (adjusted-OR=1.940, 95%CI: 1.129-3.353, P=0.017) and >60mmHg, (adjusted-OR=1.965, 95%CI: 1.011-3.846, P=0.047). Furthermore, the association of M-SPB-R and the outcome varied according to initial hematoma volume. Smaller M-SPB-R was associated with good outcome (mRS 0-2) in small (<7.42 mL) and medium-size (≥7.42 and <30.47 mL) hematomas. In contrast, while the likelihood of good outcome was low in those with large hematomas (≥30.47 mL), smaller M-SPB-R was associated with a decreasing probability of severe (mRS 5-6) outcome.

Conclusions Early M-SPB-R is associated with in-hospital outcomes in ICH. This association varies with initial hematoma volume. Early SBP reduction should consider both target levels and M-SPB-R goals vis-à-vis hematoma volume.

Authors/Disclosures
Afshin A. Divani, PhD (University of New Mexico) PRESENTER	The institution of Dr. Divani has received research support from Department of Defense.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Wendy C. Ziai, MD (Johns Hopkins Univ, Neuro Critical Care)	Dr. Ziai has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lumosa. Dr. Ziai has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bard. Dr. Ziai has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer. Dr. Ziai has received research support from NIH. Dr. Ziai has received publishing royalties from a publication relating to health care. Dr. Ziai has received personal compensation in the range of $500-$4,999 for serving as a Consultant with DOJ.
Michel T. Torbey, MD, MPH, FAAN (University of New Mexico)	Dr. Torbey has nothing to disclose.
Tom J. Moullaali, MBBS (University of Edinburgh)	Dr. Moullaali has nothing to disclose.
Alibay Jafarli, MD	Dr. Jafarli has nothing to disclose.
Michael L. James, MD (Duke University Medical Center)	Dr. James has nothing to disclose.
Stephan A. Mayer, MD (Henry Ford Hospital)	Dr. Mayer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Mayer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Phagenesis. Dr. Mayer has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Astra Zeneca. Dr. Mayer has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Mayer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Idorsia. Dr. Mayer has stock in Neuroptics. Dr. Mayer has received publishing royalties from a publication relating to health care.
Jose I. Suarez, MD, FAAN (Johns Hopkins Hospital)	Dr. Suarez has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Idorsia. Dr. Suarez has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for The Mayo Clinic.
Claude Hemphill III, MD, FAAN (Zuckerberg San Francisco General Hospital)	Dr. Hemphill has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Hemphill has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for various legal firms. The institution of Dr. Hemphill has received research support from NIH/NINDS.
Mario Di Napoli, MD (ASL Rieti)	Dr. Di Napoli has nothing to disclose.

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