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Variability in Key Physiological Parameters in Neurocritical Stroke Patients: A Multicenter Observational Study
Omar Alhaj Omar1, Patrick Schramm1,2, Tobias Frühwald1
1Department of Neurology, University Hospital Giessen and Marburg, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany.
Variability in physiological parameters like blood glucose after stroke had limited impact. Greater blood glucose variability was linked to mortality in hemorrhagic stroke, but overall, in-range variability showed limited short-term prognostic value.
Area of Science:
- Neurocritical care
- Neurology
- Intensive care medicine
Background:
- Effective management of physiological parameters is crucial in neurocritical care.
- The impact of variability within target ranges for parameters like blood pressure and glucose after stroke is not well understood.
- Studies are needed to clarify the prognostic value of physiological parameter variability post-stroke.
Purpose of the Study:
- To investigate the association between in-range variability of key physiological parameters and clinical outcomes in patients with acute stroke.
- To determine if variability in blood pressure, temperature, blood glucose, and gas exchange impacts outcomes like mortality and ventilation duration.
- To assess the prognostic value of physiological parameter variability in neurocritical care settings.
Main Methods:
- Multicenter observational study involving nine German neurocritical care units.
- Analysis of in-range physiological measurements (blood pressure, temperature, glucose, gas exchange) over 96 hours in 281 stroke patients.
- Quantification of variability using the coefficient of variation and evaluation of associations with clinical outcomes via multivariable regression.
Main Results:
- Physiological parameter variability peaked within the first 24 hours post-stroke and then stabilized.
- Increased variability in blood glucose was associated with higher in-hospital mortality in patients with hemorrhagic stroke (aOR 1.08, p=0.04).
- No significant association was found between the variability of other physiological parameters and the evaluated clinical outcomes.
Conclusions:
- In-range variability of physiological parameters has limited short-term prognostic value in neurocritical care after stroke.
- Findings support current guideline-based management strategies for physiological parameters.
- Further research may explore long-term prognostic implications or different variability metrics.
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