Abstract:

Objective

To explore the relationship between ultrasonic optic nerve sheath diameter （ONSD）， the ratio of ONSD to eyeball transverse diameter （ETD） and the prognosis of acute hemorrhagic stroke patients.

Methods

Acute hemorrhagic stroke patients （n=97） admitted to Taixing People' Hospital from October 2021 to March 2023 were categorized into groups according to hospitalization outcomes.Patients with modified Rankin scale （mRS） ≤3 points were categorized as the good prognosis group （n=61）， while those with an mRS score ＞3 points were included in the poor prognosis group（n=36）； The beside ultrasonic measurements of ONSD， ONSD/ETD， and other clinical data of patients in the two groups were compared by t-test.Significant indicators were included in the multivariate Logistic analysis to assess their association with patient prognosis following acute hemorrhagic stroke.Receiver operating characteristic （ROC） curve was plotted to evaluate the prognostic value of ultrasonic measurement of ONSD and ONSD/ETD.

Results

The poor prognosis group exhibited significantly higher values for ONSD， ONSD/ETD， and midline displacement ［（5.54±0.48） mm， （0.25±0.02）， （5.77±3.27） mm］ compared to the good prognosis group ［（4.33±0.46） mm， （0.20±0.02）， （2.52±0.97） mm；t=12.323， 10.811， 7.262， all P＜0.001］.The Glasgow coma score （GCS） were also significantly lower in the poor prognosis group ［5.01±1.98 vs 10.85±2.67； t=11.394， P＜0.001）.Multivariate Logistic regression analysis identified ONSD， ONSD/ETD， and GCS scores as prognostic factors for acute hemorrhagic stroke（OR=3.688， 2.654， 0.282； P=0.013， ＜0.001， ＜0.001）.ROC curve analysis showed that the area under the curve （AUC） for ONSD and ONSD/ETD in predicting the prognosis of acute hemorrhagic stroke were 0.970 and 0.953， respectively.With a critical value of 4.96 mm for ONSD， the sensitivity and specificity to predict the prognosis of acute hemorrhagic stroke were 91.67% and 95.08%， respectively.For ONSD/ETD， with a critical value of 0.22， the sensitivity and specificity to predict the prognosis of acute hemorrhagic stroke were 88.89% and 90.16%， respectively.The AUC of parallel test and series test were 0.901 and 0.928， respectively，with sensitivities of 91.67% and 88.89%， and specificities of 88.52% and 96.72%.

Conclusion

Both ONSD and ONSD/ETD based on ultrasonic measurements serve as effective prognostic indicators for patients with acute hemorrhagic stroke.Especially， ONSD demonstrates superior predictive efficacy， and the potential clinical benefits of combined predictive models warrant further exploration.

Key words: Acute hemorrhagic stroke, Ultrasound, Optic nerve sheath diameter, Eyeball transverse diameter