Cardiovascular predictors of in-patient mortality after subarachnoid hemorrhage
| Autor: | Nader M. Banki, Pam Rajendran, Michael T. Lawton, Adrian W. Gelb, Alexander Kopelnik, Nerissa U. Ko, Alan H. B. Wu, Sirisha Yarlagadda, Wade S. Smith, Jonathan G. Zaroff, Jacob C. Miss, William L. Young |
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| Rok vydání: | 1999 |
| Předmět: |
Adult
medicine.medical_specialty Subarachnoid hemorrhage Cardiotonic Agents Blood Pressure Critical Care and Intensive Care Medicine Cardiovascular System Phenylephrine Predictive Value of Tests Internal medicine Heart rate medicine Humans Vasospasm Intracranial cardiovascular diseases Cerebral perfusion pressure Prospective cohort study Aged Ejection fraction biology business.industry Odds ratio Middle Aged Subarachnoid Hemorrhage medicine.disease Prognosis Troponin Blood pressure Treatment Outcome Multivariate Analysis Cardiology biology.protein Neurology (clinical) business Biomarkers |
| Zdroj: | Neurocritical care. 5(2) |
| ISSN: | 1541-6933 |
| Popis: | Whether cardiac dysfunction contributes to morbidity and mortality after subarachnoid hemorrhage (SAH) remains controversial. The objective of this study was to test the hypothesis that cardiovascular abnormalities are independently related to in-patient mortality after SAH.This was a prospective cohort study of patients with aneurysmal SAH. Heart rate and blood pressure were measured, a blood sample was obtained, and echocardiography was performed on three study days, starting as soon after admission as possible. The cardiovascular predictor variables were heart rate, systolic blood pressure (SBP), cardiac troponin I (cTi) level, B-type natriuretic peptide (BNP) level, and left ventricular ejection fraction. The primary outcome measure was in-patient mortality. The association between each predictor variable and mortality was quantified by multivariate logistic regression, including relevant covariates and reporting odds ratios (OR) and 95% confidence intervals (CI).The study included 300 patients. An initial BNP level greater than 600 pg/mL was markedly associated with death (OR 37.7, p0.001). On the third study day (9.1 +/- 4.1 days after SAH symptom onset), a cTi level greater than 0.3 mg/L (OR 7.6, p = 0.002), a heart rate of 100 bpm or greater (OR 4.9, p = 0.009), and a SBP less than 130 mmHg (OR 6.7, p = 0.007) were significantly associated with death.Cardiovascular abnormalities are independent predictors of in-patient mortality after SAH. Though these effects may be explained by a reduction in cerebral perfusion pressure or other mechanisms, further research is required to determine whether or not they are causal in nature. |
| Databáze: | OpenAIRE |
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