Correlation Between Pulse Pressure And Stroke Severity And Prognosis In Acute Cerebral Hemorrhage:a Prospective Study

Objective: To explore the correlation between the different pulse pressure and stroke severity and prognosis in the acute stage of cerebral hemorrhage.Materials and Methods:1. The consecutive cases of cerebral hemorrhage were prospectively registered in the neurological wards of Sichuan Provincial People's Hospital from Feb 1, 2010 to Dec 1, 2010. 2.Diagnostic criteria(According to the WHO's criteria for cerebral hemorrhage in 1989): Acute onset, focal neurologic deficits lasting for at least 24 hours and eliminate the non-vascular cause and confirmed by CT/MRI(patients with subarachnoid hemorrhage had been excluded). 3.Inclusion Criteria:(1) According to the above-mentioned diagnostic criteria,patients with cerebral hemorrhage within 24 hours of symptom onset were included;(2)Unrestricted ages, sex, severity;(3)The patients were confirmed by CT/MRI for the first time in 24 hours of onset of cerebral hemorrhage. 4. Primary outcome measurements: (1)Mortality by the end of the 3 months follow-up period.(2)The rate of adverse outcome(death /disability) at the end of the third month follow-up. The definition of disability is one that depends on others in daily life, using modified Rankin Scale(mRS)≥3 represent disability. 5. Secondary outcome measurements : The included patients were adopted National Institutes of Health Stroke Scale (NIHSS)to evaluate the neurologic deficits degree in 24 hours after admission. NIHSS Rating: mild ( 0-6 points ) , moderate ( 7-15 points ) , serious (≥16 points).6.Statistical analysis: Used Two Chi -square test to analyze the qualitative data, T-test was adopted if the quantitative data obeys normal distribution and the variance was homogenous, Rank sum test was adopted if the quantitative data obeys abnormal distribution, Binary logistic regression or ordinal logistic regression were adopted according to different variables ( binary classification variables and orderly classification variables).Results:1. 98 cases which complied with the standards were included, 61 cases were males(62.21%);37 cases were females(37.79%);The age range of the cases was from 35 to 86 years old(65.31±11.89);13 cases were dead(11 cases died in hospital,2 cases died during the 3 months follow-up period)(13.27%);The pulse pressure level of included cases appeared approximately normal distribution;The pulse pressure in 32 cases of the total was lower than 60 mmHg( 47.00±11.28mmHg);The pulse pressure in 66 cases of the total was higher than 60 mmHg(80.15±16.60mmHg);The level of pulse pressure was 69.33±21.67mmHg;NIHSS points after admission was 7.15±4.61.2. 2.The result of multivariate logistic regression showed the older the included cases was, the higher the pulse pressure increased(OR 1.072,95%CI 1.021-1.125); Patients with the history of hypertension,diabetes had higher risk of high pulse pressure(OR3.940,95%CI 1.159-13.397;OR 10.320,95%CI 1.116-95.470);Patients with the history of smoking had higher risk of high pulse pressure(OR 6.974,95%CI 1.363-35.471).3. Primary outcome measurements: After using binary logistic regression to analyze the data, the results showed the pulse pressure after admission was independently associated with the mortality rate by the end of 3 months follow-up period(OR 1.065,95%CI 1.022-1.111),but it is not an independent risk factor for adverse outcomes(death or disability) by the end of 3 months follow-up period(P=0.711), the history of hypertension, diabetes, CHD(Coronary Artery Disease ) were independent risk factors for adverse outcomes(death or disability) by the end of 3 months follow-up period(OR 3.677,95%CI 1.021-13.236 OR 4.622,95%CI 1.253-17.046 OR5.975, 95%CI 1.231-29.003).4. Secondary outcome measurement: After using ordinary logistic regression to analyze the data, the results showed the pulse pressure after admission was independently associated with the degree of neurologic deficits(confirmed by NIHSS scale)(OR 1.863,95%CI 1.132-5.865),and age, diabetes, CHD, drinking were the independent risk factors of neurologic deficits(OR1.829,95%CI 1.311-2.552 OR 4.276,95%CI2.39 6-7.629 OR1.895,95%CI1.034-3.473 OR2.724,95%CI 1.138-3.232).Conclusion: The pulse pressure of the acute cerebral hemorrhage patients in admission is one of the independent risk factors for the degree of neurologic deficits, and also an independent risk factor to affect mortality by the end of the 3 months follow-up period, it may be a predictor of the mortality in the cerebral hemorrhage patients.