Prognostic value of Pulsatility index in acute intracerebral hemorrhage

• Published in: Neurology Vol. 61; no. 8; pp. 1051 - 1056
• Main Authors: MARTI-FABREGAS, J, BELVIS, R, GUARDIA, E, COCHO, D, MUNOZ, J, MARRUECOS, L, MARTI-VILALTA, J.-L
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 28-10-2003
• Subjects: Acute Disease; Aged; Aged, 80 and over; Biological and medical sciences; Cerebral Hemorrhage - diagnosis; Cerebral Hemorrhage - diagnostic imaging; Cerebral Hemorrhage - mortality; Comorbidity; Diastole; Female; Glasgow Coma Scale - statistics & numerical data; Humans; Intracranial Hypertension - diagnostic imaging; Intracranial Hypertension - mortality; Male; Medical sciences; Middle Cerebral Artery - diagnostic imaging; Neurology; Odds Ratio; Predictive Value of Tests; Prognosis; Prospective Studies; Pulsatile Flow; ROC Curve; Sensitivity and Specificity; Survival Rate; Systole; Ultrasonography, Doppler, Transcranial - statistics & numerical data; Vascular diseases and vascular malformations of the nervous system; Sonography; Doppler ultrasound study; Human; Nervous system diseases; Prognosis; Acute; Cardiovascular disease; Index (documentation); Cerebral disorder; Vascular disease; Transcranial route; Cerebral hemorrhage; Central nervous system disease; Cerebrovascular disease
• ISSN: 0028-3878; 1526-632X
• DOI: 10.1212/01.WNL.0000090520.67254.14

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