Risk of Shunting After Aneurysmal Subarachnoid Hemorrhage: A Collaborative Study and Initiation of a Consortium
Risk of Shunting After Aneurysmal Subarachnoid Hemorrhage: A Collaborative Study and Initiation of a Consortium
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DOI：
10.1161/strokeaha.116.013739
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发表时间：
2016-10-01
期刊：
影响因子：
8.3
通讯作者：
Huttunen, Terhi J.
中科院分区：
文献类型：
--
作者：
Adams, Hadie;Ban, Vin Shen;Huttunen, Terhi J.
背景和目的-动脉瘤性蛛网膜下腔出血(ASAH)后的分流依赖型脑积水是一种常见的后遗症，可能导致不良的神经预后，并易于进行各种干预、入院治疗和并发症。我们在一项基于人群的样本中回顾了ASAH术后的相关性，并测试了临床风险评分的可行性，以确定因脑积水而有更高分流风险的ASAH患者亚组。方法-从基于人群的东芬兰囊性颅内动脉瘤数据库(Kuopio，芬兰)中选取1533名ASAH患者进行递归分区分析，以确定ASAH术后分流的危险因素。风险模型是在随机分裂队列中建立和内部验证的。来自西南第三级动脉瘤登记处(德克萨斯州达拉斯)的946名ASAH患者进行了外部验证，并使用接收者操作特征曲线进行了测试。结果：在所有存活14天的患者中，17.7%需要永久脑脊液转流。递归分区分析确定了6个分流风险依次增加的组。这些组还依次风险12个月的分层功能结局、分流并发症和分流时间比率。探索性样本和内部验证性样本的曲线-接受者-操作特征曲线下面积分别为0.82和0.78，外部验证值为0.68。结论ASAH后分流依赖与较高的发病率和死亡率相关，分流依赖预测模型是可行的，具有临床实用价值。重要的是要识别和了解增加分流风险的因素，并消除或减轻可逆因素。ASAH-PARS联盟(动脉瘤性蛛网膜下腔出血患者分流的风险评估)已被发起，以汇集集体的见解和资源，以解决ASAH分流后依赖的关键问题，为未来的ASAH治疗指南提供信息。
Background and Purpose-Shunt dependent hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) is a common sequela that may lead to poor neurological outcome and predisposes to various interventions, admissions, and complications. We reviewed post-aSAH shunt dependency in a population-based sample and tested the feasibility of a clinical risk score to identify subgroups of aSAH patients with increasing risk of shunting for hydrocephalus.Methods-A total of 1533 aSAH patients from the population-based Eastern Finland Saccular Intracranial Aneurysm Database (Kuopio, Finland) were used in a recursive partitioning analysis to identify risk factors for shunting after aSAH. The risk model was built and internally validated in random split cohorts. External validation was conducted on 946 aSAH patients from the Southwestern Tertiary Aneurysm Registry (Dallas, TX) and tested using receiver-operating characteristic curves.Results-Of all patients alive >= 14 days, 17.7% required permanent cerebrospinal fluid diversion. The recursive partitioning analysis defined 6 groups with successively increased risk for shunting. These groups also successively risk stratified functional outcome at 12 months, shunt complications, and time-to-shunt rates. The area under the curve-receiver-operating characteristic curve for the exploratory sample and internal validation sample was 0.82 and 0.78, respectively, with an external validation of 0.68.Conclusions-Shunt dependency after aSAH is associated with higher morbidity and mortality, and prediction modeling of shunt dependency is feasible with clinically useful yields. It is important to identify and understand the factors that increase risk for shunting and to eliminate or mitigate the reversible factors. The aSAH-PARAS Consortium (Aneurysmal Subarachnoid Hemorrhage Patients' Risk Assessment for Shunting) has been initiated to pool the collective insights and resources to address key questions in post-aSAH shunt dependency to inform future aSAH treatment guidelines.