ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurocritical and Neurohospitalist Care
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1594680
This article is part of the Research TopicResearch on Precision Prevention and Treatment of Neurological and Neurodegenerative DiseasesView all 8 articles
First-day intracranial pressure correlates with ICU mortality in subarachnoid hemorrhage patients: an analysis of the MIMIC-IV database
Provisionally accepted
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing Municipality, China
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The purpose of this study was to explore the optimal intracranial pressure (ICP) distribution of subarachnoid hemorrhage (SAH) patients on the first day in the intensive care unit (ICU) using data mining methods.: Continuous ICP monitoring records of 176 SAH patients on the first ICU Day were collected from the MIMIC-IV database, comprising individuals treated at Beth Israel Deaconess Medical Center (Boston, MA) ICU between 2008 and 2019. Data underwent five-step processing:processing included rounding (to hour point), missing value imputation, resampling, min-max normalization, and time-series clustering. Four unique clusters of the SAH cohort were identified, differing by daily average and variance of ICP. Propensity score estimation was used to determine the average treatment effect of ICP management on ICU mortality based on the X-tile recommended cut-off point.The study cohort comprised 176 patients (mean age 58.8 ± 14.54 years; 58.0% [102/176] female) who met the inclusion criteria. The daily average was the only statistically significant factor in the propensity score estimation. A daily average ICP of 14 mmHg was identified as the cut-off point. The group with a daily average ICP above or below the cut-off point was an independent ICU mortality predictor in the multivariate analysis, with the largest odds ratio value among included variables. Notably, the daily average ICP was higher in ICU deaths than in survived patients under similar first-day fluid balance (ICU deaths vs. survived patients: PPearson = 0.002, R 2 = 0.25; PPearson = 0.016, R 2 = 0.04).In the study cohort collected from MIMIC-IV SAH patients, using 14 mmHg as the cutoff point for the daily average ICP on the first ICU Day demonstrated favorable ICU mortality outcomes.
Keywords: Subarachnoid Hemorrhage, Intracranial Pressure, Intensive Care Unit mortality, Time-series clustering, MIMIC-IV database
Received: 27 Mar 2025; Accepted: 20 Jun 2025.
Copyright: © 2025 Zhao, Zhang, Cao, Qu and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xin Qu, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, Beijing Municipality, China
Ning Wang, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, Beijing Municipality, China
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