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DOI: 10.1055/s-0043-1775885
Dilated optic nerve sheath by ultrasound predicts mortality among patients with acute intracerebral hemorrhage
A bainha do nervo óptico dilatada na ultrassonografia prediz mortalidade na hemorragia intraparenquimatosa agudaAbstract
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.
Resumo
Antecedentes A hemorragia intraparenquimatosa (HIP) aguda apresenta elevada morbimortalidade e a presença de hipertensão intracraniana (HIC) confere um pior prognóstico.
Objetivo Avaliamos se a dilatação do diâmetro da bainha do nervo óptico (DBNO) através do ultrassom do nervo óptico (USNO) na admissão hospitalar seria preditora de mortalidade.
Métodos Estudo multicêntrico e prospectivo de pacientes consecutivos com HIP supratentorial primária aguda admitidos em dois centros terciários. Ultrassom do nervo óptico e tomografia computadorizada (TC) de crânio foram realizados na admissão e revisados de forma cega. O desfecho primário do estudo foi a mortalidade em 3 meses. Análises de regressão logística, curva de característica de operação do receptor (ROC, na sigla em inglês) e estatística-C foram utilizadas para identificação dos preditores independentes de mortalidade.
Resultados Entre julho de 2014 e julho de 2016, 44 pacientes foram incluídos. A idade média foi 62,3 (±13,1) anos e 12 (27,3%) eram mulheres. Na análise univariada, o volume da HIP na TC de crânio, DBNO ipsilateral à HIP, glicemia, escala de coma de Glasgow (ECG) e NIHSS na admissão hospitalar, e também diabetes mellitus e não-tabagista foram preditores de mortalidade. Após análise multivariada, o DBNO ipsilateral à HIP permaneceu como preditor independente de mortalidade (odds ratio [OR]: 6,24; intervalo de confiança [IC] de 95%: 1,18–33,01; p = 0,03). O melhor ponto de corte do DBNO ipsilateral como preditor de mortalidade em 3 meses foi 5,6mm (sensibilidade 72% e especificidade 83%) e área sob a curva (AUC, na sigla em inglês) 0,71 (p = 0,02).
Conclusão O USNO é um método não-invasivo, beira-leito, de baixo custo, que pode ser empregado para estimar a presença de HIC em pacientes com HIP supratentorial primária aguda. A presença de DBNO dilatada é um preditor independente de mortalidade em 3 meses nesses pacientes.
Keywords
Cerebrovascular Disorders - Stroke - Mortality - Intracranial Hypertension - Cerebral Intraventricular Hemorrhage - Optic Nerve - UltrasonographyPalavras-chave
Transtornos Cerebrovasculares - Acidente Vascular Cerebral - Mortalidade - Hipertensão Intracraniana - Hemorragia Cerebral Intraventricular - Nervo Óptico - UltrassomEthics Approval and Consent to Participate
The local Ethics Committee approved the study (CEP HCRP 16589/2013 and CONEP 681.726). The present study was approved by the Institutional Review Board (IRB) at all centers, and all patients or legal representatives signed written informed consent for participation.
Authors' Contributions
FAD: conceptualization, data curation, formal analysis, investigation, methodology, project administration, writing – original draft; MCZZ: validation, data curation, writing – review and editing; FFAA, RKMVF, CMA, OCV, PMV: data curation, writing – review and editing; GB: data curation, formal analysis, methodology, writing – review and editing; JNG: conceptualization, formal analysis, methodology, writing – review and editing; OMPN: conceptualization, data curation, formal analysis, methodology, project administration, supervision, writing – review and editing.
Support
OMPN received research funding support from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq: 443861/2018–8; 311209/2019–0), Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP: 2016/15236–8) e Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).
Publication History
Received: 28 April 2023
Accepted: 30 July 2023
Article published online:
08 November 2023
© 2023. 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/)
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