Ultrasound Measurement Of Optic Nerve Sheath To Evaluate The Prognosis Of Stroke Patients During Hospitaliztion

Objective: The diameters of the optic nerve sheath(ONSD)were measured at 3 mm behind the globe along with the eyeball transverse diameter(ETD).The ONSD and ONSD/ETD index can detect increased intracranial hypertension(ICP).We assessed the ability of bedside ONSD and ONSD/ETD index ultrasonographic measurement to predict in-hospital survival.Methods: Eighty-three patients with stroke from November 2017 to November 2018 were selected.On the day of admission,ONSD and ETD(retina-retina)were detected by ultrasound,and the outcomes were recorded.The study population was divided into the survival group and nonsurvival group.The correlation between ONSD,ONSD/ETD and prognosis was assessed.Results: 38 of 83 patients(45.8%)survived and were discharged from the hospital.The mean ONSD and ONSD/ETD was significantly larger in nonsurvivors than survivors(5.5 mm vs.4.4 mm,P<0.01;0.3 vs.0.2,P<0.01).Locally weighted scatterplot smoothing(LOWESS)and the receiver operating characteristic(ROC)curve analysis suggested thresholds of ONSD ? 5.0 mm and ONSD/ETD ? 0.25.By adjusting the influence of confounding factors on prognosis,a prediction model was established,and the ROC curve was drawn.The area under the curve(AUC)was 0.9776.According to Youden index,the optimal predictive point of the model was 0.870,indicating excellent discriminative power(sensitivity: 0.89,specificity: 1.00).The ONSD/ETD prediction model was obtained,and the ROC curve was drawn.The area under the curve(AUC)was 0.9875.According to Youden index,the optimal prediction threshold of the model was 0.768,and the specificity for predicting adverse clinical prognosis was 0.97 with a sensitivity of 0.94.The stability of ONSD/ETD is better than that of ONSD(ONSD coefficient of variation = 0.14;ONSD/ETD coefficient of variation = 0.13).Conclusions: ONSD and ONSD/ETD were good correlated with the prognosis of critical patients with stroke.The mortality increased significantly in patients with an ONSD greater than 5.0mm and ONSD/ETD greater than 0.25.ONSD and ONSD/ETD may be promising tools for early assessment of clinical outcomes in these patients.