1013: OUTCOME FROM SPONTANEOUS INTRAPARENCHYMAL HEMORRHAGE DURING CRITICAL CARE RESUSCITATION UNIT STAY

Abstract

Introduction: Patients with spontaneous intraparenchymal hemorrhage (sIPH) often have high morbidity and mortality. Previous studies found that the first 24-hour systolic blood pressure variability (SBPV) was associated with worse functional outcome in patients. However, whether SBPV in the hyperacute phase in patients with sIPH is not known. We hypothesized that sBPV during patients’ resuscitation phase at the Critical Care Resuscitation (CCRU) at the University of Maryland Medical Center would correlate with increased hematoma progression (HP) and patients’ outcome. Methods: We retrospectively analyzed charts from adult patients who were admitted to the CCRU for management of sIPH from Jan. 2016 to Jan. 2021. Forward multivariable stepwise logistic regression was performed for the primary outcome of HP. We also performed multiple linear regression with Box-Cox transformation to normalize continuous components of BPV, namely Standard Deviation and Successive Variation in SBP (SBPSD) and SBPSV, respectively. Multivariable ordinal logistic regression was also performed for hospital disposition, ranking from discharge home to Dead/hospice. Results: We preliminarily analyzed 60 patients. Eighteen (30%) patients had HP. During CCRU stay, 23 (38%) required ventilation, 39 (65%) needed at least 1 antihypertensive infusion, 23 (38%) received hyperosmolar therapy, and 17 (28%) underwent external ventricular drain placement. Twelve (12, 20%) patients were discharged to home, 30 (50%) to rehabilitation facilities, 6 (10%) to skilled nursing homes, and 12 (20%) died. Our multivariable logistic regression found no factors in CCRU associated with HP. Highest SBP during CCRU stay (SBPmax) was associated with higher SBPSD (correlation coefficient =0.03, P< 0.001) and SBPSV (corr. coef. = 0.02, P< 0.001). High ICH score was associated with hospital disposition, higher ICH score was more likely associated with patient mortality (corr. Coeff = -1.2, OR 0.3, 95% CI 0.15-0.6, P< 0.001) Conclusions: SBPmax during CCRU stay was associated with higher SBPV in patients with sIPH during the resuscitation phase at the CCRU. Additionally, only one patients’ clinical factor, ICH score, was associated with levels of their hospital disposition. Additional studies with larger sample sizes are needed.