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.