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. 2023 Nov;165(11):3339-3351.
doi: 10.1007/s00701-023-05811-3. Epub 2023 Sep 29.

The association between blood pressure at admission and in-hospital mortality in patients with subarachnoid hemorrhage

Wei Zhou  1 , Yi He  2
Affiliations

The association between blood pressure at admission and in-hospital mortality in patients with subarachnoid hemorrhage

Wei Zhou et al. Acta Neurochir (Wien). 2023 Nov.

Abstract

Purpose: The objective of this study was to examine the association between mean arterial pressure (MAP) at admission and in-hospital mortality among patients diagnosed with subarachnoid hemorrhage (SAH).

Methods: In this cohort study, 1420 SAH patients were categorized into four groups based on quartiles of MAP: <82 mmHg group, 82-93 mmHg group, 93-103 mmHg group, and >103 mmHg group. Furthermore, the X-tile program was used to divide all patients into four groups: < 81.7 mmHg group, 81.7-92.3 mmHg group, 92.3-103.7 mmHg group, and > 103.7 mmHg group. The association between MAP and in-hospital mortality of SAH patients was evaluated using univariate and multivariable Cox proportional hazards models. A restricted cubic spline (RCS) was plotted to explore the association between MAP at admission and in-hospital mortality in patients with SAH.

Results: The median follow-up duration was 7.87 days, during which, 1219 (85.85%) patients survived. After adjusting for confounding factors, MAP <82 mmHg (hazard ratio (HR)=1.67, 95% confidence interval (CI): 1.08-2.57) or MAP >103 mmHg (HR=2.13, 95% CI: 1.38-3.29) was associated with increased risk of in-hospital mortality of SAH patients. Subgroup analysis depicted that MAP <82 mmHg or MAP >103 mmHg was associated with increased risk of in-hospital mortality in male patients or those aged ≥ 65 years. MAP >103 mmHg was linked with elevated risk of in-hospital mortality in patients aged <65 years; individuals with normal and underweight, overweight, and obesity; or people with hypertension.

Conclusion: The findings may offer a preliminary estimate of the optimum range for SAH patients for future randomized trials.

Keywords: Blood pressure; In-hospital mortality; Mean arterial pressure; Subarachnoid hemorrhage.

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