J Neurosurg Sci. 2021 Oct 14. doi: 10.23736/S0390-5616.21.05477-1. Online ahead of print.
ABSTRACT
INTRODUCTION: The subarachnoid hemorrhage due to a ruptured brain aneurysm is a neurological emergency with high mobility and mortality. Hypertensive states are related to a bad prognosis and a higher risk of a ruptured aneurysm. However, the relationship between the blood pressure variability with the aneurysmal subarachnoid hemorrhage and its prognosis is quite unknown.
EVIDENCE ACQUISITION: A systematic review was performed across the databases. The following descriptors and related were used for the search: “blood pressure”, “arterial pressure”, variability, subarachnoid hemorrhage, hemorrhage, aneurysmal, aneurysmal subarachnoid hemorrhage. The following data were extracted: Glasgow Outcome Scale or Modified Rankin Scale, and blood pressure variabilities to categorize the prognosis.
EVIDENCE SYNTHESIS: 5 studies were selected. The blood pressure variability and the related outcome were assessed by mean systolic blood pressure and minimum systolic blood. The meta-analysis of mean systolic blood pressure (cut-off >95.3 mmHg) showed an odds ratio of 11.23 (CI 95%: 4,423 to 28,537) (p=<0.001), predicting the good outcome after the aneurysmal subarachnoid hemorrhage. The pooled analysis revealed AUC of the ROC predicting the good outcome was statistically significant (AUC:0.85, p<0.001). The pooled data analysis of minimum systolic blood pressure revealed an odds ratio of 6.43 (CI 95%:2.834-14.589, P <0,001) and AUC of the pooled ROC 0.931 (CI95%:0,851 to 1,000, P <0,001) to predict poor outcome. The funnel plot through Egger’s test for the analysis showed different grades of asymmetry.
CONCLUSIONS: The blood pressure variability (mean and minimum systolic blood pressure) is a good predictor and parameter in the aneurysmal subarachnoid hemorrhage prognosis and outcome prediction.
PMID:34647715 | DOI:10.23736/S0390-5616.21.05477-1
