Optic nerve sheath diameter as a new noninvasive marker for predicting the prognosis of patients with acute ischemic stroke in the intensive care unit

Abstract

Objective: Intracranial hypertension is linked to poor prognosis after acute ischemic stroke (AIS). Intracranial pressure can be evaluated by using the ultrasonographic optic nerve sheath diameter (ONSD) and transcranial Doppler (TCD). This study aims to determine whether ONSD and TCD parameters could noninvasively predict the prognosis of AIS patients. Design: Prospective observational blinded study. Setting: Neurology intensive care unit (ICU). Patients: Consecutive patients with AIS. Interventions: ONSD and TCD parameters of 81 AIS patients were obtained upon admission. The Glasgow Outcome Scale scores were evaluated at the 6-month follow-up. The clinical differences between the poor and good prognosis groups were compared. The association between variables and prognosis was assessed, and the cutoff values for the Glasgow Coma Scale (GCS) score and ONSD for predicting poor prognoses were analyzed. Measurements and main results: At the 6-month follow-up, 54 patients had poor prognosis; the ONSDs of the poor and good prognosis groups were 5.45±0.38 and 4.96±0.32, respectively (P<0.001). There were no significant differences in TCD parameters between the two groups. ONSD (odds ratio [OR] 1.4; 95% confidence interval [CI], 1.2–1.7; P<0.001) and GCS score (OR, 0.7; 95% CI, 0.5–0.9; P=0.003) were independent factors influencing poor prognosis. The best ONSD cutoff value for poor prognosis was 5.21 mm; the sensitivity, specificity, and area under the curve were 87.0%, 82.1%, and 0.862, respectively. Conclusions: Ultrasonographic measurement of ONSD may be a new prognostic indicator of functional outcomes in ICU AIS patients. However, TCD parameters have no significant prognostic value for AIS patients.