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. 2025 Jul 15:18:3951-3960.
doi: 10.2147/IJGM.S525766. eCollection 2025.

Paroxysmal Sympathetic Hyperactivity, Volume Status, and Neurological Prognosis in Acute Brain Injury: A Prospective Cohort Analysis

Rongping Chen #  1 , Xin Cai #  2 , Xiying Gui  2 , Guoying Lin  2 , Wei Du  3
Affiliations

Paroxysmal Sympathetic Hyperactivity, Volume Status, and Neurological Prognosis in Acute Brain Injury: A Prospective Cohort Analysis

Rongping Chen et al. Int J Gen Med. .

Abstract

Objective: In this study, we enrolled patients with acute brain injury (ABI) to examine the relationship between paroxysmal sympathetic hyperactivity (PSH) and volume status, right heart function, and pulmonary edema, and their impact on prognosis.

Methods: Thirty patients with ABI were prospectively enrolled. A correlation analysis between Paroxysmal Sympathetic Hyperactivity Assessment Measure (PSH-AM) score and clinical indicators was performed using Pearson's or Spearman correlation coefficient. Receiver operating characteristic (ROC) curves were used to assess the prediction of 6-month Glasgow Outcome Scale Extended (GOSE) score. Inferior vena cava (IVC) diameter was evaluated as a marker of intravascular volume status, and its correlation with 6-month GOSE score in ABI patients was analyzed.

Results: There was no statistically significant difference in PSH-AM over time in patients with ABI (P = 0.791). The PSH-AM scores on Days 3 (R = 0.474, P = 0.08) and 5 (R = 0.460, P = 0.011) were positively correlated with pulmonary edema score. Early diastolic velocity (EDV) on Days 3 (R = -0.429, P = 0.018) and 5 (R = -0.452, P = 0.012) was negatively correlated with pulmonary edema score. Ejection time (ET) on Day 5 was positively correlated with inferior vena cava (IVC) (R = -0.381, P = 0.038). The ability to assess the 6-month GOSE score and the ROC curve (AUC) was observed for IVC on Day 1 (AUC = 0.785± 0.120, 95% confidence interval 0.550-1.000, P = 0.012).

Conclusion: IVC diameter assessed on day 1 is a useful indicator of neurological prognosis in patients with ABI. There was no statistically significant difference in PSH over time in patients with ABI. Regarding the study's sample size and potential operator bias in IVC diameter measurement, the findings require validation in larger, multicenter studies with standardized measurement protocols.

Keywords: Glasgow outcome scale extended; acute brain injury; paroxysmal sympathetic hyperactivity; right cardiogenic pulmonary edema; right heart function; volume status.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Correlations between Paroxysmal Sympathetic Hyperactivity Assessment Measure (PSH-AM) and clinical indicators in patients with ABI. (a) Correlation between PSH-AM and pulmonary edema score. (b) Correlation between early diastolic velocity (EM) and pulmonary edema score. (c) Correlation between ejection time (ET) and inferior vena cava (IVC) diameter. P < 0.05 was considered statistically significant.
Figure 2
Figure 2
Prediction of the GOSE score using receiver operating characteristic curves.
See this image and copyright information in PMC

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References

    1. Huang M, Wang J, Ni X, Chen G, Kong L. Neurocritical care in China: past, present, and future. World Neurosurg. 2016;95:502–506. doi: 10.1016/j.wneu.2016.06.102 - DOI - PubMed
    1. Broessner G, Helbok R, Lackner P, et al. Survival and long-term functional outcome in 1,155 consecutive neurocritical care patients. Crit Care Med. 2007;35(9):2025–2030. doi: 10.1097/01.ccm.0000281449.07719.2b - DOI - PubMed
    1. China’s battle with stroke. Lancet Neurol. 2008;7(12):1073. doi: 10.1016/S1474-4422(08)70245-X - DOI - PubMed
    1. Maegele M. Global traumatic brain injury research enters a new era. Lancet Neurol. 2020;19(8):637–639. doi: 10.1016/S1474-4422(20)30208-8 - DOI - PubMed
    1. Stein SC, Georgoff P, Meghan S, Mizra K, Sonnad SS. 150 years of treating severe traumatic brain injury: a systematic review of progress in mortality. J Neurotrauma. 2010;27(7):1343–1353. doi: 10.1089/neu.2009.1206 - DOI - PubMed

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