Skin sympathetic nerve activity as a biomarker for outcomes in spontaneous intracerebral hemorrhage

Abstract

Objective: A rapid and accurate forecast for the early prognosis of ICH patients is challenging. This study investigated whether heart rate variability (HRV) and skin sympathetic nerve activity (SKNA) could prognosticate poor neurological outcomes in ICH patients. Methods: Between November 2020 and November 2021, we studied 92 spontaneous ICH patients in the First Affiliated Hospital of Nanjing Medical University. Glasgow Outcome Scale (GOS) score at 2 weeks after the ICH was used to categorize patients into good and poor outcome groups. The modified Rankin Scale (mRS) assessed patients' ability to live independently for 1 year. We utilized a portable high-frequency electrocardiogram (ECG) recording system to record the HRV and SKNA information in ICH patients and control participants. Results: 77 patients were eligible for the prediction of neurological outcome and were allocated into the good (n = 22) or poor (n = 55) outcome groups based on the GOS grade. In univariate logistic regression analysis, significant variables that could differentiate the outcomes were age, hypertension, tracheal intubation, Glasgow Coma Scale (GCS) score, existing intraventricular hemorrhage, white blood cells, neutrophil, lnVLF, lnTP, and aSKNA. Variables in the best fit multivariable logistic regression model were age, hypertension, GCS score, neutrophils, and aSKNA. The GCS score was the only independent risk factor for poor outcomes. At 30 days and 1 year of follow-up, patients with lower aSKNA had poor outcomes. Interpretation: ICH patients had reduced aSKNA, which could be a prognostic indicator. A lower aSKNA suggested a worse prognosis. The present data indicate that ECG signals could be helpful for prognosticating ICH patients.

Autonomic dysfunction and treatment strategies in intracerebral hemorrhage

“…The burst amplitude is correlated to both skin blood flow reduction rate and sweat rate change. As a non‐invasive sympathetic activity assessment method, SSNA has been widely used to predict sympathetic tone in cardiac diseases, neurological disorders, sleep apnea, etc 112–116 . The ICH classification and outcome prediction based on the SSNA signal had been proved to be a feasible method 114 .…”

“…As a non‐invasive sympathetic activity assessment method, SSNA has been widely used to predict sympathetic tone in cardiac diseases, neurological disorders, sleep apnea, etc. 112 , 113 , 114 , 115 , 116 The ICH classification and outcome prediction based on the SSNA signal had been proved to be a feasible method. 114 Sympathetic skin response (SSR) is also a kind of epidermal potential that is related to sweat gland activity and reflects the function of sympathetic nervous system.…”