Abstract
Background: Shock index (SI - heart rate/systolic blood pressure) has been studied as a measure of haemodynamic status. We aimed to determine whether SI measures within 72 hours of admission were associated with adverse outcomes in intracerebral haemorrhage (ICH).
Methods: Patients were drawn from the Virtual International Stroke Trials Archive6 Intracerebral Haemorrhage (VISTA-ICH). Multivariable Cox regressions modelled the relationship between SI (on admission, 24, 48, 72 hours) and mortality (at 3-, 7-, and 90-days), 90-day incident pneumonia and cardiovascular events (MACE). Ordinal logistic regressions modelled the relationship between SI and 90-day modified Rankin Scale (mRS).
Results: 979 patients were included. Baseline SI was not associated with mortality. 24h SI >0.7 was associated with 7-day mortality (hazard ratio (95% confidence interval) = 3.14 (1.37-7.19)). 48h and 72h SI >0.7 were associated with 7-day (4.23 (2.07-8.66) and 3.24 (1.41-7.42) respectively) and 90-day mortality (2.97 (1.82-4.85) and 2.05 (1.26-3.61) respectivley). SI <0.5 at baseline, 48h and 72h was associated with decreased pneumonia risk. 24h and 48h SI >0.7was associated with increased MACE risk. 48h and 72h SI >0.7 was associated with increased odds of higher 90-day mRS.
Conclusion: Higher-than-normal SI subsequent to initial encounter was associated with higher post-ICH mortality at 3, 7, and 90 days. Lower-than-normal SI was associated with a decreased risk of incident pneumonia.
Methods: Patients were drawn from the Virtual International Stroke Trials Archive6 Intracerebral Haemorrhage (VISTA-ICH). Multivariable Cox regressions modelled the relationship between SI (on admission, 24, 48, 72 hours) and mortality (at 3-, 7-, and 90-days), 90-day incident pneumonia and cardiovascular events (MACE). Ordinal logistic regressions modelled the relationship between SI and 90-day modified Rankin Scale (mRS).
Results: 979 patients were included. Baseline SI was not associated with mortality. 24h SI >0.7 was associated with 7-day mortality (hazard ratio (95% confidence interval) = 3.14 (1.37-7.19)). 48h and 72h SI >0.7 were associated with 7-day (4.23 (2.07-8.66) and 3.24 (1.41-7.42) respectively) and 90-day mortality (2.97 (1.82-4.85) and 2.05 (1.26-3.61) respectivley). SI <0.5 at baseline, 48h and 72h was associated with decreased pneumonia risk. 24h and 48h SI >0.7was associated with increased MACE risk. 48h and 72h SI >0.7 was associated with increased odds of higher 90-day mRS.
Conclusion: Higher-than-normal SI subsequent to initial encounter was associated with higher post-ICH mortality at 3, 7, and 90 days. Lower-than-normal SI was associated with a decreased risk of incident pneumonia.
Original language | English |
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Article number | 106994 |
Number of pages | 7 |
Journal | Clinical Neurology and Neurosurgery |
Volume | 210 |
Early online date | 26 Oct 2021 |
DOIs | |
Publication status | Published - 30 Nov 2021 |
Bibliographical note
ACKNOWLEDGEMENTSThe following individuals should be indexed on PubMed as collaborators - VISTA-ICH Steering Committee: DF Hanley (Chair), K Butcher, S Davis, B Gregson, KR Lees, P Lyden, S Mayer, K Muir, and T Steiner
Keywords
- intracerebral haemorrhage
- stroke
- mortality
- shock index
- blood pressure