Rongping Chen,1,* Xin Cai,2,* Xiying Gui,2 Guoying Lin,2 Wei Du3 

1Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China; 2Department of Critical Care Medicine, Tibet Autonomous Region People’s Hospital, Lhasa, People’s Republic of China; 3Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Wei Du, Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People’s Republic of China, Tel +13691018276, Email pink_dallas@126.com

Objective: In this study, we enrolled patients with acute brain injury (ABI) to examine the relationship between paroxysmal sympathetic hyperactivity (PSH) and volume status, right heart function, and pulmonary edema, and their impact on prognosis.
Methods: Thirty patients with ABI were prospectively enrolled. A correlation analysis between Paroxysmal Sympathetic Hyperactivity Assessment Measure (PSH-AM) score and clinical indicators was performed using Pearson’s or Spearman correlation coefficient. Receiver operating characteristic (ROC) curves were used to assess the prediction of 6-month Glasgow Outcome Scale Extended (GOSE) score. Inferior vena cava (IVC) diameter was evaluated as a marker of intravascular volume status, and its correlation with 6-month GOSE score in ABI patients was analyzed.
Results: There was no statistically significant difference in PSH-AM over time in patients with ABI (P = 0.791). The PSH-AM scores on Days 3 (R = 0.474, P = 0.08) and 5 (R = 0.460, P = 0.011) were positively correlated with pulmonary edema score. Early diastolic velocity (EDV) on Days 3 (R = − 0.429, P = 0.018) and 5 (R = − 0.452, P = 0.012) was negatively correlated with pulmonary edema score. Ejection time (ET) on Day 5 was positively correlated with inferior vena cava (IVC) (R = − 0.381, P = 0.038). The ability to assess the 6-month GOSE score and the ROC curve (AUC) was observed for IVC on Day 1 (AUC = 0.785± 0.120, 95% confidence interval 0.550– 1.000, P = 0.012).
Conclusion: IVC diameter assessed on day 1 is a useful indicator of neurological prognosis in patients with ABI. There was no statistically significant difference in PSH over time in patients with ABI. Regarding the study’s sample size and potential operator bias in IVC diameter measurement, the findings require validation in larger, multicenter studies with standardized measurement protocols.

Keywords: acute brain injury, paroxysmal sympathetic hyperactivity, volume status, right heart function, right cardiogenic pulmonary edema, Glasgow outcome scale extended