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Neurological Pupil Index and Delayed Cerebral Ischemia after Subarachnoid Hemorrhage: A Retrospective Multicentric Study

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Abstract

Background

Delayed cerebral ischemia (DCI) occurs in around 30% of patients suffering from nontraumatic subarachnoid hemorrhage (SAH) and is associated with poor neurological outcome. Whether the Neurological Pupil index (NPi) derived from the automated pupillometry could help to diagnose the occurrence of DCI remains unknown. The aim of this study was to investigate the association of NPi with the occurrence of DCI in patients with SAH.

Methods

This was a multicenter, retrospective cohort study of consecutive patients with SAH admitted to the intensive care units of five hospitals between January 2018 and December 2020 who underwent daily NPi recordings (every 8 h) during the first 10 days of admission. DCI was diagnosed according to standard definitions (in awake patients) or based on neuroimaging and neuromonitoring (in sedated or unconscious patients). An NPi < 3 was defined as abnormal. The primary outcome of the study was to assess the time course of daily NPi between patients with DCI and patients without DCI. Secondary outcome included the number of patients who had an NPi < 3 before DCI.

Results

A total of 210 patients were eligible for the final analysis; DCI occurred in 85 (41%) patients. Patients who developed DCI had similar values of mean and worst daily NPi over time when compared with patients without DCI. Patients with DCI had a higher proportion of at least one NPi < 3 at any moment before DCI when compared with others (39/85, 46% vs. 35/125, 38%, p = 0.009). Similarly, the worst NPi before DCI diagnosis was lower in the DCI group when compared with others (3.1 [2.5–3.8] vs. 3.7 [2.7–4.1], p = 0.05). In the multivariable logistic regression analysis, the presence of NPi < 3 was not independently associated with the development of DCI (odds ratio 1.52 [95% confidence interval 0.80–2.88]).

Conclusions

In this study, NPi measured three times a day and derived from the automated pupillometry had a limited value for the diagnosis of DCI in patients with SAH.

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Author information

Author notes

  1. Elisa Gouvêa Bogossian, Aaron Blandino Ortiz are equally contributed as first author.

Authors and Affiliations

  1. Department of Intensive Care, Hopital Universitaire de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium

    Elisa Gouvêa Bogossian, Valentina Esposito, Giuseppina Giannì, Elisabetta Macchini & Fabio Silvio Taccone

  2. Intensive Care Department, Hospital Universitario Ramón y Cajal, Madrid, Spain

    Aaron Blandino Ortiz & Raúl de Pablo Sanchez

  3. Departament of Medicine and Medical Specialties, University of Alcalá, Madrid, Spain

    Aaron Blandino Ortiz & Raúl de Pablo Sanchez

  4. Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy

    Anselmo Caricato & Luca Pisapia

  5. Department of Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil

    Cassia Righy Shinotsuka, Ricardo Turon, Bruno Gonçalves & Pedro Kurtz

  6. Laboratório de Medicina Intensiva, Fundação Oswaldo Cruz, Instituto Nacional de Infectologia, Rio de Janeiro, Brazil

    Cassia Righy Shinotsuka

  7. Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clínico Universitario de Valencia, Valencia, Spain

    Berta Monléon Lopez & Rafael Badenes

  8. Department of Surgery, University of Valencia, Valencia, Spain

    Rafael Badenes

  9. INCLIVA Health Research Institute, Valencia, Spain

    Rafael Badenes

  10. D’Or Institute of Research and Education, Rio de Janeiro, Brazil

    Pedro Kurtz

Authors
  1. Elisa Gouvêa Bogossian
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Contributions

EGB, ABO, and FST contributed to conception and design of the study. VE, EGB, ABO, GG, EM, PL, RT, BG, and BML collected data and performed data curation. EGB and FST performed the statistical analysis. EGB, VE, and FST wrote the first draft of the manuscript. ABO, AC, CRS, RP, RB and PK, revised the manuscript for intellectual content and English editing. All authors contributed to manuscript revision, read, and approved the submitted version.

Corresponding author

Correspondence to Elisa Gouvêa Bogossian.

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Conflicts of interest

FST is a scientific advisor for Neuroptics Inc. The other authors declare that they have no competing interests regarding this article.

Ethical approval/informed consent

The study followed ethical guidelines and the local Ethics Committees approved this study in each participating center (Erasme University Hospital, Hospital Universitario Ramón y Cajal, Fondazione Policlinico Universitario A. Gemelli, Paulo Niemeyer State Brain Institute, and Hospital Clínico Universitario de Valencia). According to local legislation, written informed consent for study participation was obtained from a patient family member or a legal representative.

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Gouvêa Bogossian, E., Blandino Ortiz, A., Esposito, V. et al. Neurological Pupil Index and Delayed Cerebral Ischemia after Subarachnoid Hemorrhage: A Retrospective Multicentric Study. Neurocrit Care 39, 116–124 (2023). https://doi.org/10.1007/s12028-023-01744-y

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