Clinical response following hypertension induction for clinical delayed cerebral ischemia following subarachnoid hemorrhage: A retrospective, multicenter, cohort study

Autor: Maud A. Tjerkstra, Marcella C. A. Müller, Bert A. Coert, Friso W. A. Hoefnagels, Mervyn D. I. Vergouwen, Peter van Vliet, Lizzy Ooms, Gabriël J. E. Rinkel, Arjen J. C. Slooter, Wouter A. Moojen, Korné Jellema, W. Peter Vandertop, Dagmar Verbaan
Přispěvatelé: Graduate School, ANS - Neurovascular Disorders, Intensive Care Medicine, ACS - Pulmonary hypertension & thrombosis, Neurosurgery, CCA - Cancer Treatment and Quality of Life, ANS - Systems & Network Neuroscience, Amsterdam Neuroscience - Neurovascular Disorders, Amsterdam Neuroscience - Systems & Network Neuroscience, CCA - Imaging and biomarkers
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: European journal of neurology. Wiley-Blackwell
Tjerkstra, M A, Müller, M C A, Coert, B A, Hoefnagels, F W A, Vergouwen, M D I, van Vliet, P, Ooms, L, Rinkel, G J E, Slooter, A J C, Moojen, W A, Jellema, K, Vandertop, W P & Verbaan, D 2023, ' Clinical response following hypertension induction for clinical delayed cerebral ischemia following subarachnoid hemorrhage : A retrospective, multicenter, cohort study ', European Journal of Neurology, vol. 30, no. 8 . https://doi.org/10.1111/ene.15833
European Journal of Neurology. Wiley-Blackwell
ISSN: 1351-5101
DOI: 10.1111/ene.15833
Popis: Background: Hypertension induction (HTI) is often used for treating delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH); however, high-quality studies on its efficacy are lacking. We studied immediate and 3−/6-month clinical efficacy of HTI in aSAH patients with clinical DCI. Methods: A retrospective, multicenter, comparative, observational cohort study in aSAH patients with clinical deterioration due to DCI, admitted to three tertiary referral hospitals in the Netherlands from 2015 to 2019. Two hospitals used a strategy of HTI (HTI group) and one hospital had no such strategy (control group). We calculated adjusted relative risks (aRR) using Poisson regression analyses for the two primary (clinical improvement of DCI symptoms at days 1 and 5 after DCI onset) and secondary outcomes (DCI-related cerebral infarction, in-hospital mortality, and poor clinical outcome [modified Rankin Scale 4–6] assessed at 3 or 6 months), using the intention-to-treat principle. We also performed as-treated and per-protocol analyses. Results: The aRR for clinical improvement on day 1 after DCI in the HTI group was 1.63 (95% CI 1.17–2.27) and at day 5 after DCI 1.04 (95% CI 0.84–1.29). Secondary outcomes were comparable between the groups. The as-treated and per-protocol analyses yielded similar results. Conclusions: No clinical benefit of HTI is observed 5 days after DCI due to spontaneous reversal of DCI symptoms in patients treated without HTI. The 3−/6-month clinical outcome was similar for both groups. Therefore, these data suggest that one may consider to not apply HTI in aSAH patients with clinical DCI.
Databáze: OpenAIRE