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Admission rate-pressure product as an early predictor for in-hospital mortality after aneurysmal subarachnoid hemorrhage

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Abstract

Early prediction of in-hospital mortality in aneurysmal subarachnoid hemorrhage (aSAH) is essential for the optimal management of these patients. Recently, a retrospective cohort observation has reported that the rate-pressure product (RPP, the product of systolic blood pressure and heart rate), an objective and easily calculated bedside index of cardiac hemodynamics, was predictively associated with in-hospital mortality following traumatic brain injury. We thus wondered whether this finding could also be generalized to aSAH patients. The current study aimed to examine the association of RPP at the time of emergency room (ER) admission with in-hospital mortality and its predictive performance among aSAH patients. We retrospectively included 515 aSAH patients who had been admitted to our ER between 2016 and 2020. Their baseline heart rate and systolic blood pressure at ER presentation were extracted for the calculation of the admission RPP. Meanwhile, we collected relevant clinical, laboratory, and neuroimaging data. Then, these data including the admission RPP were examined by univariate and multivariate analyses to identify independent predictors of hospital mortality. Eventually, continuous and ordinal variables were selected from those independent predictors, and the performance of these selected predictors was further evaluated and compared based on receiver operating characteristic (ROC) curve analyzes. We identified both low (< 10,000; adjusted odds ratio (OR) 3.49, 95% CI 1.93–6.29, p < 0.001) and high (> 15,000; adjusted OR 8.42, 95% CI 4.16–17.06, p < 0.001) RPP on ER admission to be independently associated with in-hospital mortality after aSAH. Furthermore, after centering the admission RPP by its median, the area under its ROC curve (0.761, 95% CI 0.722–0.798, p < 0.001) was found to be statistically superior to any of the other independent predictors included in the ROC analyzes (all p < 0.01). In light of the predictive superiority of the admission RPP, as well as its objectivity and easy accessibility, it is indeed a potentially more applicable predictor for in-hospital death in aSAH patients.

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Data supporting the study is available from the corresponding author on reasonable demand.

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Funding

This work was supported by the Yangfan Project for Key Medical Programs from the Hospital Authority of Beijing (Grant number ZYLX202109, Grant recipient: Shi G) and the Major Projects from Beijing Municipal Science and Technology Commission (Grant number Z201100005520039, Grant recipient: Shi G). Neither of the funders play any role in the study design, data collection and analysis, decision to publish, or write-up of the manuscript.

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Authors and Affiliations

  1. Division of Emergency and Critical Care Medicine, Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China

    Jingwei Zhao, Shaolan Zhang, Jiawei Ma, Guangzhi Shi & Jianxin Zhou

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  1. Jingwei Zhao
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  3. Jiawei Ma
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  4. Guangzhi Shi
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Contributions

Conceptualization and study design: Zhao J., Shi G., and Zhou J.; funding acquisition: Shi G.; study supervision: Shi G.; data acquisition and curation: Zhang S. and Ma J.; formal analysis: Zhao J.: writing—original draft: Zhao J.; all authors have reviewed, critically revised, and approved the final manuscript submitted.

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Correspondence to Guangzhi Shi.

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This study was performed in accordance with the principles of the Declaration of Helsinki and was approved by the Institutional Review Board of Bejing Tiantan Hospital (approval number: KY-2021–025-003).

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Because of the retrospective and observational design of the study, informed written consent was not required according to the regulations of the local ethics committee.

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The authors declare no competing interests.

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Zhao, J., Zhang, S., Ma, J. et al. Admission rate-pressure product as an early predictor for in-hospital mortality after aneurysmal subarachnoid hemorrhage. Neurosurg Rev 45, 2811–2822 (2022). https://doi.org/10.1007/s10143-022-01795-3

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