Peak blood pressure and prediction of posterior reversible encephalopathy syndrome in children

Autor:	Andrew M South, Abanti Chaudhuri, Emily Gall
Rok vydání:	2020
Předmět:	Male medicine.medical_specialty Hypertensive encephalopathy Mean arterial pressure Adolescent Systole 030232 urology & nephrology Diastole Blood Pressure Neuroimaging 030204 cardiovascular system & hematology Risk Assessment Severity of Illness Index Article 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Reference Values Risk Factors Internal medicine medicine Humans Hypertensive emergency Child Receiver operating characteristic business.industry Area under the curve Brain Blood Pressure Determination Posterior reversible encephalopathy syndrome medicine.disease Magnetic Resonance Imaging Blood pressure ROC Curve Nephrology Case-Control Studies Child Preschool Hypertension Pediatrics Perinatology and Child Health Cardiology Feasibility Studies Female Posterior Leukoencephalopathy Syndrome business
Zdroj:	Pediatr Nephrol
ISSN:	1432-198X 0931-041X
DOI:	10.1007/s00467-020-04577-5
Popis:	BACKGROUND: Hypertension is a risk factor for posterior reversible encephalopathy syndrome (PRES), but the timing and severity of hypertension relative to PRES are unknown. The objective was to identify a clinically meaningful blood pressure (BP) threshold that predicts PRES development in high-risk children. METHODS: We recorded peak systolic BP, diastolic BP, BP z-scores, and mean arterial pressure over the 14 days preceding clinical concern for PRES in 35 subjects who developed PRES, compared to 14 controls who had normal brain magnetic resonance imaging and similar underlying disease, renal function, and medications. We used multivariable logistic regression models adjusted for fluid overload and obesity to estimate the association of peak BP with PRES. We used receiver operating characteristic curves to determine which peak BP thresholds best predicted PRES and calculated the corresponding sensitivity, specificity, and positive and negative predictive values. RESULTS: Peak systolic BP z-score was most strongly associated with PRES (OR 3.97, 95% CI 1.62–9.74), and peak systolic BP z-score ≥ 3.0 predicted PRES (area under the curve 0.95, 95% CI 0.88–1.0) with 91% sensitivity and 85% specificity, indicating 94% positive predictive value and 79% negative predictive value. CONCLUSIONS: We demonstrated that peak systolic BP z-score ≥ 3.0 in the preceding 14 days predicted PRES development in cases compared with controls in children at high risk. Our study suggests that stage 2 hypertension, corresponding to a z-score ≥ 3.0, could help define hypertensive emergency in high-risk children and indicate when more aggressive treatment is warranted to prevent neurologic injury.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::971fe2bc2d7acbeeb88becbcc7479b3b https://doi.org/10.1007/s00467-020-04577-5 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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