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Prognostic value of Pulsatility Index in acute intracerebral hemorrhage

From the Departments of Neurology (Drs. Martí–Fàbregas, Belvís, Cocho, and Martí–Vilalta), Internal Medicine (Dr. Muñoz), and Intensive Care (Dr. Marruecos) and Neuroradiological Section (Dr. Guardia), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain.

Address correspondence and reprint requests to Dr. J. Martí–Fàbregas, Servei de Neurologia, Hospital de la Santa Creu i Sant Pau, Avda. Sant Antoni M. Claret, 167, 08025 Barcelona, Spain; e-mail: jmarti{at}hsp.santpau.es

Objective: To investigate whether data obtained by transcranial Doppler (TCD) have prognostic value in patients with intracerebral hemorrhage (ICH).

Methods: A prospective study of patients with an acute (<12 hours from onset of symptoms) spontaneous supratentorial ICH was conducted. Mortality was assessed at 30-day follow-up. TCD parameters were obtained from both middle cerebral arteries: systolic, diastolic, and mean velocities and Pulsatility Index (PI) from the affected and unaffected hemispheres. The following variables were included in a univariate analysis: age, sex, hematoma volume, hypodense volume around the hematoma, total volume, midline shift, ventricular size, Glasgow Coma Scale score, intraventricular hemorrhage, body temperature, white cell count, blood glucose, mean blood pressure, and TCD data. A multivariate analysis was performed with variables that showed significance in the univariate analysis. Receiver-operator characteristic (ROC) curves were obtained.

Results: Forty-eight patients (age 66.5 ± 12.5 years; 28 men) were studied. Mortality at 30 days was 31%. The only predictor of mortality was the Glasgow Coma Scale score (odds ratio [OR] 0.67, CI 0.53 to 0.84, p = 0.001), whereas the PI from the unaffected hemisphere was correlated with mortality (OR 2.3, CI 0.92 to 5.72, p = 0.07). The area under the ROC curve was 0.92. A cutoff for PI from the unaffected hemisphere of 1.75 showed a specificity of 94% and a sensitivity of 80% as a predictor of death at 30 days.

Conclusions: The PI of the unaffected hemisphere may be a predictor of death in acute ICH. These findings suggest that intracranial hypertension is the most likely cause of death in most patients with ICH.

Received February 9, 2003. Accepted in final form June 10, 2003.

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