Risk Factors and Clinical Impact of Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: Analysis from the China National Stroke Registry
Risk Factors and Clinical Impact of Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: Analysis from the China National Stroke Registry
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DOI：
10.1159/000487325
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发表时间：
2018-01-01
影响因子：
5.7
通讯作者：
Liu, Liping
中科院分区：
文献类型：
--
作者：
Duan, Wanying;Pan, Yuesong;Liu, Liping
背景：蛛网膜下腔出血（aSAH）后的迟发性脑缺血（DCI）是发病率和死亡率的重要原因。虽然检测DCI的早期体征很重要，但DCI高风险患者很难识别，潜在的风险因素也不确定。本研究旨在确定DCI的独立危险因素，并阐明其对预后和病程的临床影响。研究方法：对于这项全国性、多中心、前瞻性临床研究，纳入了从中国国家卒中登记中心招募的连续aSAH患者，记录了住院期间的人口统计学、临床、放射学和实验室数据、院内并发症、功能结局和3、6和12个月的死亡率。使用单变量和多变量logistic回归确定与DCI发展相关的风险因素，评估DCI对短期和长期结局的贡献。结果：在所有504例aSAH患者中，155例发生DCI。多因素分析显示，女性、糖尿病史、Hunt和Hess分级4-5、世界神经外科学会联合会分级IV-V是DCI的独立危险因素。DCI与高住院并发症和高支持干预利用率相关。DCI还导致出院时以及3、6和12个月后的功能结局较差和死亡率较高。结论：女性、糖尿病史和临床分级差是发生DCI的独立早期风险因素，有助于更好地识别DCI高风险患者。在中国aSAH患者中，DCI与严重的临床病程、不良结局和短期和长期死亡率相关。(C)2018 S. Karger AG，巴塞尔
Background: Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) is a significant cause of morbidity and mortality. While it is important to detect early signs of DCI, patients with high risk of DCI are difficult to identify, and the potential risk factors are uncertain. This study aimed to identify independent risk factors of DCI and clarify their clinical impact on outcome and the disease course. Methods: For this nationwide, multicenter, prospective clinical study involving consecutive patients with aSAH recruited from the China National Stroke Registry, demographic, clinical, radiological, and laboratorial data during hospitalisation, in-hospital complications, functional outcomes, and mortality at 3, 6, and 12 months were recorded. Using univariate and multivariate logistic regression to determine risk factors associated with the development of DCI, the contribution of DCI to short- and long-term outcomes was evaluated. Results: Of all 504 patients with aSAH, 155 developed DCI. Multivariate analysis revealed that being female, a history of diabetes mellitus, a Hunt and Hess grade of 4-5, and a World Federation of Neurosurgical Societies grade of IV-V were independent risk factors of DCI. DCI was associated with high in-hospital complications, and with a high utilization rate of supporting interventions. DCI also contributed to poorer functional outcome and higher mortality at discharge and after 3, 6, and 12 months. Conclusions: Female sex, a history of diabetes mellitus, and poor clinical grade are independent early risk factors for the development of DCI and can contribute to a better identification of patients at a high risk for DCI. DCI was associated with severe clinical course, poor outcome, and mortality both in the short- and long-term in patients with aSAH in China. (C) 2018 S. Karger AG, Basel