Dilated optic nerve sheath by ultrasound predicts mortality among patients with acute intracerebral hemorrhage.

Autor:	Dias FA; Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil., Zotin MCZ; Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Medicina Interna, Divisão de Radiologia, Ribeirão Preto SP, Brazil.; Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States., Alessio-Alves FF; Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil., Martins Filho RKDV; Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil., Barreira CMA; Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil., Vincenzi OC; Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil., Venturelli PM; Universidad del Desarrollo, Facultad de Medicina Clínica Alemana, Instituto de Ciencias e Innovación en Medicina, Centro de Estudios Clínicos, Santiago, Chile., Boulouis G; Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States., Goldstein JN; Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States., Pontes-Neto OM; Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
Jazyk:	angličtina
Zdroj:	Arquivos de neuro-psiquiatria [Arq Neuropsiquiatr] 2023 Oct; Vol. 81 (10), pp. 861-867. Date of Electronic Publication: 2023 Nov 08.
DOI:	10.1055/s-0043-1775885
Abstrakt:	Background: Intracerebral hemorrhage (ICH) is a deadly disease and increased intracranial pressure (ICP) is associated with worse outcomes in this context. Objective: We evaluated whether dilated optic nerve sheath diameter (ONSD) depicted by optic nerve ultrasound (ONUS) at hospital admission has prognostic value as a predictor of mortality at 90 days. Methods: Prospective multicenter study of acute supratentorial primary ICH patients consecutively recruited from two tertiary stroke centers. Optic nerve ultrasound and cranial computed tomography (CT) scans were performed at hospital admission and blindly reviewed. The primary outcome was mortality at 90-days. Multivariate logistic regression, ROC curve, and C-statistics were used to identify independent predictors of mortality. Results: Between July 2014 and July 2016, 57 patients were evaluated. Among those, 13 were excluded and 44 were recruited into the trial. Their mean age was 62.3 ± 13.1 years and 12 (27.3%) were female. On univariate analysis, ICH volume on cranial CT scan, ICH ipsilateral ONSD, Glasgow coma scale, National Institute of Health Stroke Scale (NIHSS) and glucose on admission, and also diabetes mellitus and current nonsmoking were predictors of mortality. After multivariate analysis, ipsilateral ONSD (odds ratio [OR]: 6.24; 95% confidence interval [CI]: 1.18-33.01; p  = 0.03) was an independent predictor of mortality, even after adjustment for other relevant prognostic factors. The best ipsilateral ONSD cutoff was 5.6mm (sensitivity 72% and specificity 83%) with an AUC of 0.71 ( p  = 0.02) for predicting mortality at 90 days. Conclusion: Optic nerve ultrasound is a noninvasive, bedside, low-cost technique that can be used to identify increased ICP in acute supratentorial primary ICH patients. Among these patients, dilated ONSD is an independent predictor of mortality at 90 days. Competing Interests: The authors have no conflict of interest to declare. (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/).)
Databáze:	MEDLINE
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