Prognostic values of optic nerve sheath diameter for comatose patients with acute stroke: An observational study

Sha Zhu, Chao Cheng, Liu-Liu Wang, Dian-Jiang Zhao, Yuan-Li Zhao, Xian-Zeng Liu, Sha Zhu, Chao Cheng, Liu-Liu Wang, Dian-Jiang Zhao, Yuan-Li Zhao, Xian-Zeng Liu

Abstract

Background: Optic nerve sheath diameter (ONSD) measurement is one of the non-invasive methods recommended for increased intracranial pressure (ICP) monitoring.

Aim: This study aimed to evaluate the roles of optic nerve sheath diameter (ONSD) and ONSD/eyeball transverse diameter (ETD) ratio in predicting prognosis of death in comatose patients with acute stroke during their hospitalization.

Methods: A total of 67 comatose patients with acute stroke were retrospectively recruited. The ONSD and ETD were measured by cranial computed tomography (CT) scan. All patients underwent cranial CT scan within 24 h after coma onset. Patients were divided into death group and survival group according to their survival status at discharge. The differences of the ONSD and ONSD/ETD ratio between the two groups and their prognostic values were compared.

Results: The ONSD and ONSD/ETD ratio were 6.07 ± 0.72 mm and 0.27 ± 0.03 in the comatose patients, respectively. The ONSD was significantly greater in the death group than that in the survival group (6.32 ± 0.67 mm vs 5.65 ± 0.62 mm, t = 4.078, P < 0.0001). The ONSD/ETD ratio was significantly higher in the death group than that in the survival group (0.28 ± 0.03 vs 0.25 ± 0.02, t = 4.625, P < 0.0001). The area under the receiver operating characteristic curve was 0.760 (95%CI: 0.637-0.882, P < 0.0001) for the ONSD and 0.808 (95%CI: 0.696-0.920, P < 0.0001) for the ONSD/ETD ratio.

Conclusion: The mortality increased in comatose patients with acute stroke when the ONSD was > 5.7 mm or the ONSD/ETD ratio was > 0.25. Both indexes could be used as prognostic tools for comatose patients with acute stroke. The ONSD/ETD ratio was more stable than the ONSD alone, which would be preferred in clinical practice.

Keywords: Coma; Eyeball transverse diameter; Intracranial pressure; Optic nerve sheath diameter; Prognosis; Stroke.

Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.

Figures

Figure 1
Figure 1
Measurement methods for optic nerve sheath diameter and eyeball transverse diameter. A: The optic nerve sheath diameter was measured at 3 mm behind the eyeball by the cranial computed tomography (CT) scan; B: Eyeball transverse diameter was measured by the cranial CT scan.
Figure 2
Figure 2
Receiver operating characteristic curves for comparing the efficiency of the optic nerve sheath diameter and optic nerve sheath diameter/eyeball transverse diameter ratio in predicting prognosis of comatose patients with acute stroke. ONSD: Optic nerve sheath diameter; ETD: Eyeball transverse diameter.

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Source: PubMed

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