| Background: Increased intracranial pressure(ICP)is a common emergency and critical illness in neurology.It is necessary to diagnose elevated ICP timely and accurately,and give timely and effective treatment to avoid adverse clinical outcomes.Invasive ICP monitoring is considered to be the gold standard for diagnosing elevated ICP,but it is prone to complications such as infection and bleeding.There are many noninvasive methods for monitoring ICP,such as transcranial dopple(TCD),which can diagnose elevated ICP through changes in blood flow rate,spectral shape,and pulsatility index(PI).There is still controversy,and there is a problem of poor acoustic window penetration.It can also be diagnosed through imaging changes,but it is not suitable for patients who require continuous monitoring and severe illness.Among many non-invasive auxiliary examinations,ultrasound measurement of optic nerve sheath diameter(ONSD)is the current research hotspot.Thicked ONSD was found in patients with elevated ICP.In addition,a few studies have found elevated optic discs under ultrasound in patients with elevated ICP,but it is still unclear whether it can be used to diagnose elevated ICP and what the diagnostic capabilities are.On the basis of the existing ONSD measurement,it is unknown whether adding the measurement of the optic disc height(ODH)will help improve the diagnosis of elevated ICP.Based on the above-mentioned problems,we intend to explore whether ultrasound measurement of ODH can be used to evaluate elevated ICP and whether ultrasound measurement of ONSD combined with ODH diagnosis can improve the diagnosis of elevated ICP.Methods: We recruited patients who needed lumbar puncture in the Department of Neurology and collected clinical data of these patients.Before the patient undergoes a lumbar puncture,an ultrasound examination is performed to measure ONSD and ODH.Taking lumbar puncture pressure as ICP,it is divided into elevated ICP group and normal ICP group according to the level of ICP.Compare baseline data and ultrasound data between the two groups.Carry out single factor analysis and multi-factor analysis to obtain independent influencing factors that affect ICP.Generate ROC curve,determine the cutoff value of elevated ICP for ONSD and ODH diagnosis,and compare their abilities in diagnosing elevated ICP.Various statistical methods such as t test,Wilcoxon rank sum test,Pearson and Spearman correlation analysis,Bland-Altman test,De Long test,etc.will be used for analysis during the research process.Results: A total of 111 patients were recruited(mean age 44.59±17.01 years old,66 men).There are 56 people in the elevated ICP group.There was no statistical difference in baseline data between the two groups.Both ONSD and ODH in the elevated ICP group were higher than those in the normal ICP group(ONSD: 5.03±0.37 mm vs.4.19±0.37 mm,p<0.001;ODH: 0.82(0.61-1.08)mm vs.0.39(0-0.60)mm,p <0.001).ICP was positively correlated with ONSD(r=0.799,p<0.001)and ODH(r=0.692,p<0.001).Both ONSD and ODH are independent influencing factors of ICP.The cutoff value of ODH for diagnosing elevated ICP is 0.63 mm,the sensitivity and specificity are 73% and84%,respectively,and the AUROC is 0.850.The cutoff value of ONSD for diagnosing elevated ICP is 4.68 mm,the sensitivity and specificity are 84% and95%,respectively,and the AUROC is 0.937.ONSD is superior to ODH in diagnosing elevated ICP(p=0.0347).The maximum AUROC of ONSD combined with ODH in diagnosing high ICP is 0.968,and the highest sensitivity is 93%.Conclusion:(1)The cutoff value of ONSD to diagnose elevated ICP by ultrasound measurement is 4.68 mm,and ONSD is positively correlated with ICP.(2)Ultrasonic measurement of ODH can also be used to diagnose elevated ICP.Its cutoff value is 0.63 mm,but it is not as sensitive as ONSD.ODH is positively correlated with ICP.(3)Ultrasonic measurement of ONSD combined with ODH can improve the sensitivity of diagnosing elevated ICP... |
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