Intracranial Hypertension After Spontaneous Intracerebral Hemorrhage: A Systematic Review and Meta-analysis of Prevalence and Mortality Rate
The objective of this study was to determine the prevalence of intracranial hypertension (IHT) and the associated mortality rate in patients who suffered from primary intracerebral hemorrhage (ICH). A secondary objective was to assess predisposing factors to IHT development. We conducted a systematic literature search of major electronic databases (MEDLINE, EMBASE, and Cochrane Library), for studies that assessed intracranial pressure (ICP) monitoring in patients with acute ICH. Study level and outcome measures were extracted. The meta-analysis was performed using a random-effects model. A total of six studies comprising 381 patients were pooled to estimate the overall prevalence of any episode of IHT (ICP > 20 mmHg) after ICH. The pooled prevalence rate for any episode of IHT after ICH was 67% (95% CI 51–84%). Four studies comprising 239 patients were pooled in order to estimate the overall mortality rate associated with IHT. Pooled mortality rate was 50% (95% CI 24–76%). For both outcomes, heterogeneity was statistically significant, and risk of bias was nonsignificant. Reported variables correlated significantly with increased ICP were lower Glasgow Coma Scale score at admission, midline shift, hemorrhage volume, and hydrocephalus. The prevalence and mortality rates associated with IHT after ICH are high and may be underestimated. Predicting factors for the development of IHT reflect the magnitude of the primary injury. However, the results of present meta-analysis should be interpreted with caution due to methodological limitations such as selection bias of patients who had ICP monitoring, and lack of standardized IHT definition.
KeywordsIntracerebral hemorrhage Intracranial hypertension Intracranial pressure Meta-analysis Prevalence Mortality
Glasgow Outcome Scale
External ventricular drain
DAG: design of the study, definition of intellectual content, literature search, data acquisition, data analysis, manuscript editing and manuscript preparation. RAN: design of the study, definition of intellectual content, literature search, data acquisition, data analysis, statistical analyses, manuscript editing and manuscript preparation. AZ: design of the study, data analysis, statistical analyses and manuscript editing. WCZ, JCH: definition of intellectual content, data acquisition, data analysis and manuscript editing.
Source of support
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Conflict of interest
Daniel A. Godoy, Rafael A. Núñez-Patiño, Andres Zorrilla-Vaca and J. Claude Hemphill declares that they have no conflict of interest and Dr. Ziai reports personal fees from Headsense, Inc., outside the submitted work.
- 1.Hemphill JC 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, Fung GL, Goldstein JN, Macdonald RL, Mitchell PH, Scott PA, Selim MH, Woo D. American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke. 2015;46:2032–60.CrossRefGoogle Scholar
- 2.de Oliveira Manoel AL, Goffi A, Zampieri FG, Turkel-Parrella D, Duggal A, Marotta TR, Macdonald RL, Abrahamson S. The critical care management of spontaneous intracranial hemorrhage: a contemporary review. Crit Care. 2016;20:272. https://doi.org/10.1186/s13054-016-1432-0.CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Steiner T, Al-Shahi Salman R, Beer R, Christensen H, Cordonnier C, Csiba L, Forsting M, Harnof S, Klijn CJ, Krieger D, Mendelow AD, Molina C, Montaner J, Overgaard K, Petersson J, Roine RO, Schmutzhard E, Schwerdtfeger K, Stapf C, Tatlisumak T, Thomas BM, Toni D, Unterberg A, Wagner M. European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke. 2014;9:840–55.CrossRefGoogle Scholar
- 18.Wells G, Shea B, O’Connell B et al. The Newcastle–Ottawa scale (NOS) for assessing the quality of non-randomised studies in meta-analyses. Ottawa: University of Ottawa; 2009.Google Scholar