Objectives: Intracranial pressure (ICP) monitors have been used in some patients with spontaneous intracranial hemorrhage (ICH) to provide information to guide treatment without clear evidence for its use in this population. We assessed the impact of ICP monitor placement, including external ventricular drains and intraparenchymal monitors, on neurologic outcome in this population.

Materials and Methods

In this secondary analysis of the Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation III trial, the primary outcome was poor outcome (modified Rankin Scale score 4-6) and the secondary outcome was death, at 1 year from onset. We compared outcomes in patients with or without an ICP monitor using unadjusted and adjusted logistic regression models. The analyses were repeated in a balanced cohort created with propensity score matching.

Results

Seventy patients underwent ICP monitor placement and 424 did not. Poor outcome was seen in 77.1% of patients in the ICP-monitor subgroup compared with 53.8% in the no-monitor subgroup (p<0.001). Of patients in the ICP-monitor subgroup, 31.4% died, compared with 21.0% in the no-monitor subgroup (p=0.053). In multivariate models, ICP monitor placement was associated with a >2-fold greater risk of poor outcome (odds ratio 2.76, 95% CI 1.30–5.85, p=0.008), but not with death (p=0.652). Our findings remained consistent in the propensity score-matched cohort.

Conclusion

These results question whether ICP monitor–guided therapy in patients with spontaneous nontraumatic ICH improves outcome. Further work is required to define the causal pathway and improve identification of patients that might benefit from invasive ICP monitoring.

中文翻译：

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颅内压监测仪引导治疗对自发性非创伤性颅内出血后神经系统结果的影响

目的：颅内压（ICP）监测仪已被用于一些自发性颅内出血（ICH）患者，以提供指导治疗的信息，但尚无明确证据表明该监测仪在该人群中的使用。我们评估了 ICP 监测仪的放置（包括心室外引流管和脑实质内监测仪）对该人群神经系统结果的影响。

材料和方法

在微创手术加阿替普酶治疗脑出血清除 III 试验的二次分析中，主要结局是不良结局（改良 Rankin 量表评分 4-6），次要结局是发病 1 年后死亡。我们使用未调整和调整的逻辑回归模型比较了有或没有 ICP 监测仪的患者的结果。在通过倾向评分匹配创建的平衡队列中重复进行分析。

结果

70 名患者接受了 ICP 监测，424 名患者则没有。ICP 监测亚组中 77.1% 的患者预后不良，而无监测亚组中这一比例为 53.8% ( p <0.001)。ICP 监测亚组的患者中有 31.4% 死亡，而无监测亚组的患者死亡率为 21.0% ( p =0.053)。在多变量模型中，放置 ICP 监测仪与不良结果风险增加 2 倍以上相关（比值比 2.76，95% CI 1.30-5.85，p = 0.008），但与死亡无关（p = 0.652）。我们的研究结果在倾向评分匹配队列中保持一致。

结论

这些结果质疑 ICP 监测引导治疗自发性非创伤性 ICH 患者是否可以改善预后。需要进一步的工作来确定因果途径并改进对可能受益于侵入性 ICP 监测的患者的识别。