Abstract 026: High In-Hospital Systolic Blood Pressure Variability and Poor Functional Outcomes in Primary Intracerebral Hemorrhage Patients

Abstract

Introduction: High in-hospital SBP variability (HSBPV) is an emerging marker for poor outcomes among Intracerebral Hemorrhage (ICH) patients. We aimed to determine the risk of severe disability or death (SDD) at day-90 among ICH patients with HSPBV and explore pre-hospital factors associated with HSPBV. Methods: Adult, radiologically confirmed primary ICH patients were prospectively enrolled and followed-up until day-90. All routinely collected SBP values were recorded for the inpatient stay. Inter and intra-patient SBPV was quantified using generalized estimating equations. Modified Rankin Scale (mRS) Score of 4 - 6 was defined as SDD. Poisson and logistic regression models were fit to determine the risk of day-90 SDD, and the association of pre-hospital characteristics with HSBPV. Results: A total of 566 patients [mean age: 63.5, females 36.6% (207 of 566)] were included. Total in-hospital follow-up period was 4,908 days [median (IQR) per patient = 8.7 (3-11)]. Over 120,500 SBP readings were analyzed. Inter and intra-patient mean SBP standard deviation (SD) was 11.1 and 13.2, respectively. A SD of 13.0 was parameterized as a cut-off for HSBPV. HSBPV patients had a 17% higher adjusted risk of day-90 SDD (Relative Risk, 95% CI: 1.17, 1.02-1.35) (Table). Older age and female sex were independently associated with HSBPV after controlling for hemorrhage volume, pre-morbid mRS, and Glasgow Coma Scale (Figure). Conclusion: Quantification of HSBPV is feasible utilizing routinely collected SBP readings. HSBPV is associated with poor outcomes. Elderly and female patients may be more likely to demonstrate HSBPV during hospitalization.