COMPARISON OF BIS VALUE PARAMETERS MAX, MIN AND MEAN IN EVALUATING THE PROGNOSIS OF PATIENTS WITH ACUTE CEREBRAL HEMORRHAGE

Lei Lu^{1, #}, Pengling Xu^{2, #}, Qun Liu^{3, *}

¹Department of Emergency, The Second Affiliated Hospital of Jiaxing University, Jiaxing, PR China - ²Department of Rehabilitation Medicine, The Affiliated Huai’an Hospital of Xuzhou Medical University and The Second People’s Hospital of Huai’an, Huai’an, PR China - ³Department of Neurology, Lianshui County People's Hospital, Huai’an, PR China

Objective: The BIS value parameters, max, min, and mean, were analyzed to evaluate their prognostic value for patients with acute cerebral hemorrhage.

Method: 78 patients with acute cerebral hemorrhage were randomly selected from those who had been admitted to our hospital between October 2017 and July 2019. According to the prognosis of patients, they were divided into a good-prognosis group and a poor-prognosis group. Each patient’s invasive arterial pressure was monitored and recorded. The pupils’ light reflection and the Glasgow prognostic score (GPS) were employed. Then, the skin of a patient’s forehead was wiped with alcohol and dried, before an electrode pad was attached on the surgical site. The patient was continuously monitored for 12h for the maximum BIS value (BIS value_max) and monitored every 1h for the minimum BIS value (BIS value_min); finally, the average BIS value was calculated (BIS value mean). The ROC curve and the Youden index were applied to compare the BIS parameters, max, min, and mean. The Glasgow prognostic scores (GPSs), changes in the calcium ion-binding protein 100 (S100 protein), and neuron-specific enolase (NSE) levels were analyzed.

Results: The GPSs of the good-prognosis group were significantly higher than those of the poor-prognosis group, and the difference was statistically significant (p<0.05). The expressions of serum indexes for S100 and NSE were significantly lower than those for the poor-prognosis group, and that difference was also statistically significant (p<0.05). The pupil reflectance, BIS value_max, BIS value_min, and BIS value mean results for the good-prognosis group were significantly higher than those for the poor-prognosis group, and the difference was statistically significant (p<0.05). The areas under the ROC curve were (95% CI: 0.845-0.957), (95% CI: 0.768-0.903), and (95% CI: 0.811-0.945); see Figure 1. The BIS value_max for sensitivity and specificity were 82.30% and 84.70%, BIS value_min for sensitivity and specificity were 84.5% and 70.20%, and the BIS value_mean for sensitivity and specificity were 90.50% and 75.60%, respectively. These results demonstrate that the BIS value max plays the greatest role in evaluating the prognosis of patients with acute cerebral hemorrhage.

Conclusion: The BIS value can objectively and directly reflect the degree of cerebral oxygen consumption, thereby indicating the degree of a cerebral hemorrhage, in patients with acute cerebral hemorrhage. The method of investigation is simple and convenient, and extremely important for evaluating the prognosis of patients with cerebral hemorrhage. Among the three values, the BIS value max is the most accurate in evaluating the prognosis of patients with acute cerebral hemorrhage.