Background: Subarachnoid hemorrhage (SAH) results from extravasation of blood into the subarachnoid space and is associated with high morbidity and mortality. This study aimed to compare systolic blood pressure variability (SBPV) and intracranial pressure variability (ICPV) in three 8 h intervals during the first 24 h after hospital admission and investigate their associations with discharge disposition and in-hospital mortality. Methods: We retrospectively reviewed charts of adult patients with spontaneous, non-traumatic SAH admitted for at least 24 h from 2016 to 2020. Hourly measurements were recorded for both systolic blood pressure (SBP) and intracranial pressure (ICP), and SBPV and ICPV were measured using successive variation (SV) and standard deviation (SD). Results: A total of 240 patients were included (mean age 57 ± 14.2 years, 64.6% female); 40 (16.7%) died. Univariate analyses showed higher SBP-SV (22.7 ± 13.8) in the first 8 h to be significantly associated with mortality (p = 0.028) and not being discharged home (p = 0.022), compared to those who survived (17.6 ± 7.5) or were discharged home (16.7 ± 5.5). Multivariate logistic regression did not show an association between SBPV and outcomes of interest. Conclusions: Greater early SBPV was associated with mortality in univariate analysis but was not independently predictive after adjustment for clinical severity, suggesting it reflects underlying physiologic instability rather than an independent prognostic factor in SAH.
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