Dilated optic nerve sheath by ultrasound predicts mortality among patients with acute intracerebral hemorrhage
Journal
Arquivos de Neuro-Psiquiatria
ISSN
0004-282X
1678-4227
Date Issued
2023
Author(s)
Francisco Antunes Dias
Maria Clara Zanon Zotin
Frederico Fernandes Alessio-Alves
Rui Kleber do Vale Martins Filho
Clara Monteiro Antunes Barreira
Otavio Costa Vincenzi
Gregoire Boulouis
Joshua Norkin Goldstein
Octavio Marques Pontes-Neto
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:title>Abstract</jats:title><jats:p>
Background Intracerebral hemorrhage (ICH) is a deadly disease and increased intracranial pressure (ICP) is associated with worse outcomes in this context.</jats:p><jats:p>
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.</jats:p><jats:p>
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.</jats:p><jats:p>
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.</jats:p><jats:p>
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.</jats:p>
Background Intracerebral hemorrhage (ICH) is a deadly disease and increased intracranial pressure (ICP) is associated with worse outcomes in this context.</jats:p><jats:p>
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.</jats:p><jats:p>
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.</jats:p><jats:p>
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.</jats:p><jats:p>
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.</jats:p>
Cite this document
Dias, F. A., Zotin, M. C. Z., Alessio-Alves, F. F., Martins Filho, R. K. D. V., Barreira, C. M. A., Vincenzi, O. C., Venturelli, P. M., Boulouis, G., Goldstein, J. N., & Pontes-Neto, O. M. (2023). Dilated optic nerve sheath by ultrasound predicts mortality among patients with acute intracerebral hemorrhage. Arquivos de Neuro-Psiquiatria, 81(10), 861-867. https://doi.org/10.1055/s-0043-1775885
Subjects
cerebral intraventricular hemorrhage
;
cerebrovascular disorders
;
intracranial hypertension
;
mortality
;
optic nerve
;
stroke
;
ultrasonography
;
aged
;
cerebral hemorrhage
;
female
;
humans
;
intracranial hypertension
;
intracranial pressure
;
male
;
middle aged
;
optic nerve
;
prospective studies
;
stroke
;
ultrasonography
;
acetylsalicylic acid
;
antihypertensive agent
;
glucose
;
hydroxymethylglutaryl coenzyme a reductase inhibitor
;
adult
;
alcohol consumption
;
anticoagulation
;
area under the curve
;
article
;
brain hemorrhage
;
cerebrovascular accident
;
cerebrovascular disease
;
chronic liver disease
;
clinical article
;
clinical outcome
;
computer assisted tomography
;
craniotomy
;
current smoker
;
diabetes mellitus
;
diagnostic test accuracy study
;
diastolic blood pressure
;
echoencephalography
;
echography
;
female
;
glasgow coma scale
;
glucose blood level
;
hematoma
;
human
;
hypertension
;
intracranial hypertension
;
intracranial pressure
;
kolmogorov smirnov test
;
longitudinal study
;
major clinical study
;
male
;
middle aged
;
mortality
;
multicenter study
;
national institutes of health stroke scale
;
observational study
;
optic nerve
;
optic nerve sheath diameter
;
prospective study
;
receiver operating characteristic
;
sensitivity and specificity
;
systolic blood pressure
;
transient ischemic attack
;
aged
;
brain hemorrhage
;
cerebrovascular accident
;
clinical trial
;
diagnostic imaging
;
echography
;
intracranial hypertension
;
physiology
;
procedures