Neurological Pupil Index and Delayed Cerebral Ischemia after Subarachnoid Hemorrhage: A Retrospective Multicentric Study

Elisa Gouvêa Bogossian^#¹, Aaron Blandino Ortiz^#^{2

3}, Valentina Esposito⁴, Anselmo Caricato⁵, Cassia Righy Shinotsuka^{6

7}, Berta Monléon Lopez⁸, Giuseppina Giannì⁴, Elisabetta Macchini⁴, Raúl de Pablo Sanchez^{2

3}, Luca Pisapia⁵, Ricardo Turon⁶, Bruno Gonçalves⁶, Rafael Badenes^{8

9

10}, Pedro Kurtz^{6

11}, Fabio Silvio Taccone⁴

Affiliations

¹ Department of Intensive Care, Hopital Universitaire de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium. elisa.gouvea.bogossian@ulb.be.
² Intensive Care Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
³ Departament of Medicine and Medical Specialties, University of Alcalá, Madrid, Spain.
⁴ Department of Intensive Care, Hopital Universitaire de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium.
⁵ Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
⁶ Department of Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil.
⁷ Laboratório de Medicina Intensiva, Fundação Oswaldo Cruz, Instituto Nacional de Infectologia, Rio de Janeiro, Brazil.
⁸ Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clínico Universitario de Valencia, Valencia, Spain.
⁹ Department of Surgery, University of Valencia, Valencia, Spain.
¹⁰ INCLIVA Health Research Institute, Valencia, Spain.
¹¹ D'Or Institute of Research and Education, Rio de Janeiro, Brazil.

^# Contributed equally.

PMID: 37225941
DOI: 10.1007/s12028-023-01744-y

Multicenter Study

Neurological Pupil Index and Delayed Cerebral Ischemia after Subarachnoid Hemorrhage: A Retrospective Multicentric Study

Elisa Gouvêa Bogossian et al. Neurocrit Care. 2023 Aug.

. 2023 Aug;39(1):116-124.

doi: 10.1007/s12028-023-01744-y. Epub 2023 May 24.

Authors

Affiliations

¹ Department of Intensive Care, Hopital Universitaire de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium. elisa.gouvea.bogossian@ulb.be.
² Intensive Care Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
³ Departament of Medicine and Medical Specialties, University of Alcalá, Madrid, Spain.
⁴ Department of Intensive Care, Hopital Universitaire de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium.
⁵ Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
⁶ Department of Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil.
⁷ Laboratório de Medicina Intensiva, Fundação Oswaldo Cruz, Instituto Nacional de Infectologia, Rio de Janeiro, Brazil.
⁸ Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clínico Universitario de Valencia, Valencia, Spain.
⁹ Department of Surgery, University of Valencia, Valencia, Spain.
¹⁰ INCLIVA Health Research Institute, Valencia, Spain.
¹¹ D'Or Institute of Research and Education, Rio de Janeiro, Brazil.

^# Contributed equally.

PMID: 37225941
DOI: 10.1007/s12028-023-01744-y

Abstract

Background: Delayed cerebral ischemia (DCI) occurs in around 30% of patients suffering from nontraumatic subarachnoid hemorrhage (SAH) and is associated with poor neurological outcome. Whether the Neurological Pupil index (NPi) derived from the automated pupillometry could help to diagnose the occurrence of DCI remains unknown. The aim of this study was to investigate the association of NPi with the occurrence of DCI in patients with SAH.

Methods: This was a multicenter, retrospective cohort study of consecutive patients with SAH admitted to the intensive care units of five hospitals between January 2018 and December 2020 who underwent daily NPi recordings (every 8 h) during the first 10 days of admission. DCI was diagnosed according to standard definitions (in awake patients) or based on neuroimaging and neuromonitoring (in sedated or unconscious patients). An NPi < 3 was defined as abnormal. The primary outcome of the study was to assess the time course of daily NPi between patients with DCI and patients without DCI. Secondary outcome included the number of patients who had an NPi < 3 before DCI.

Results: A total of 210 patients were eligible for the final analysis; DCI occurred in 85 (41%) patients. Patients who developed DCI had similar values of mean and worst daily NPi over time when compared with patients without DCI. Patients with DCI had a higher proportion of at least one NPi < 3 at any moment before DCI when compared with others (39/85, 46% vs. 35/125, 38%, p = 0.009). Similarly, the worst NPi before DCI diagnosis was lower in the DCI group when compared with others (3.1 [2.5-3.8] vs. 3.7 [2.7-4.1], p = 0.05). In the multivariable logistic regression analysis, the presence of NPi < 3 was not independently associated with the development of DCI (odds ratio 1.52 [95% confidence interval 0.80-2.88]).

Conclusions: In this study, NPi measured three times a day and derived from the automated pupillometry had a limited value for the diagnosis of DCI in patients with SAH.

Keywords: Neuromonitoring; Pupillary light reflex; Stroke; Vasospasm.

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Comment in

Quantitative Pupillometry: Not a Clear Predictor of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage.
Ong CJ. Ong CJ. Neurocrit Care. 2023 Aug;39(1):34-35. doi: 10.1007/s12028-023-01709-1. Epub 2023 May 24. Neurocrit Care. 2023. PMID: 37225940 Free PMC article. No abstract available.

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Neurological Pupil Index and Delayed Cerebral Ischemia after Subarachnoid Hemorrhage: A Retrospective Multicentric Study

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Neurological Pupil Index and Delayed Cerebral Ischemia after Subarachnoid Hemorrhage: A Retrospective Multicentric Study

Authors

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