Blood pressure variability and mortality in patients admitted with acute stroke in a tertiary care stroke centre (2016–2019): a retrospective cohort study
Bibliographic record
Abstract
OBJECTIVES: The influence of short-term variations in blood pressure (BP) in acute stroke on clinical outcomes remains uncertain. Our study explores the relationship between BP variability (BPV) from stroke admission up to 72 hours and in-hospital and 1-year mortality. DESIGN: Retrospective observational cohort study. SETTING: Hamad General Hospital (HGH) a tertiary care stroke centre in Qatar. PARTICIPANTS: 2820 participants were initially included. After the exclusion of ineligible subjects, 2554 patients (82.5% male, median age 53±9 years) were included. 893 (34.96%) were from the Middle East and North Africa, 1302 (50.98%) were from South Asia, 258 (10.10%) from Southeast Asia, 9 (0.35%) were from East Asia and 92 (3.60%) were from other regions. Eligible participants were adult patients above 18 years of age who presented with acute ischaemic or haemorrhagic stroke. Excluded individuals were those younger than 18 years, had incomplete data, had transient ischaemic attack (TIA), had severe hypoglycaemia on admission (<3.3 mmol/L) or had a history of chronic kidney disease (CKD). INTERVENTIONS: We measured the BP every 4 hours over 3 days with a total of 18 readings from stroke admission. We then categorised BPV into five (L1-L5) and four (L1-L4) levels for systolic and diastolic BPs, respectively, and evaluated their association with mortality. RESULTS: There were increased odds of in-hospital mortality with increased systolic and diastolic variability (L2, OR 2.64, 95% CI 1.44 to 4.84; L3, OR 4.20 95% CI 2.14 to 8.24; L4, OR 10.14, 95% CI 4.93 to 20.85; L5, OR 23.18, 95%CI 10.88 to 49.37), (p=0.002 to <0.001) and (L2, OR 1.61, 95% CI 0.96 to 2.69; L3, OR 2.95, 95% CI 1.70 to 5.12 and L4, OR 8.00, 95% CI 4.49 to 14.25), (p=0.071 to <0.001), respectively. This was consistent with 1-year mortality for systolic and diastolic BPs. CONCLUSION: In a retrospective cohort of ethnically diverse acute stroke patient population, BPV was significantly associated with both in-hospital and 1-year mortality. Further prospective research is needed to define BPV and establish interventions and management accordingly.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".