Heart-Rate-to-Blood-Pressure Ratios Correlate with Malignant Brain Edema and One-Month Death in Large Hemispheric Infarction: A Cohort Study.

Introduction: Large hemispheric infarction (LHI) can lead to fatal complications such as malignant brain edema (MBE). We aimed to investigate the correlation between heart-rate-to-blood-pressure ratios and MBE or one-month death after LHI. Methods: We prospectively included LHI patients from a registered cohort. Hourly heart-rate-to-blood-pressure ratios were recorded as a variation of the traditional shock index (SI), SI_s and SI_d (systolic and diastolic pressures, respectively), and calculated for mean and variability (standard deviation) in 24 h and two 12 h epochs (1–12 h and 13–24 h) after onset of symptoms. MBE was defined as neurological deterioration symptoms with imaging evidence of brain swelling. We employed a generalized estimating equation to compare the trend in longitudinal collected SI_s and SI_d between patients with and without MBE. We used multivariate logistic regression to investigate the correlation between SI_s, SI_d and outcomes. Results: Of the included 162 LHI patients, 28.4% (46/162) developed MBE and 25.3% (40/158) died within one month. SI_s and SI_d increased over baseline in all patients, with a similar ascending profile during the first 12 h epoch and a more intensive increase in the MBE group during the second 12 h epoch (p < 0.05). During the overall 24 h, patients with greater SI_d variability had a significantly increased MBE risk after adjustment (OR 3.72, 95%CI 1.38–10.04). Additionally, during the second 12 h epoch (13–24 h after symptom onset), patients developing MBE had a significantly higher SI_d level (OR 1.18, 95%CI 1.00–1.39) and greater SI_d variability (OR 3.16, 95%CI 1.35–7.40). Higher SI_d and greater SI_d variability within 24 h independently correlated with one-month death (all p < 0.05). Within the second 12 h epoch, higher SI_s, higher SI_d and greater SI_d variability independently correlated with one-month death (all p < 0.05). No significant correlation was observed in the first 12 h epoch. Conclusions: Higher and more fluctuated heart-rate-to-blood-pressure ratios independently correlated with MBE development and one-month death in LHI patients, especially during the second 12 h (13–24 h) epoch after onset. [ABSTRACT FROM AUTHOR]