Impact of intraventricular hemorrhage measured by Graeb and LeRoux score on case fatality risk and chronic hydrocephalus in aneurysmal subarachnoid hemorrhage
Impact of intraventricular hemorrhage measured by Graeb and LeRoux score on case fatality risk and chronic hydrocephalus in aneurysmal subarachnoid hemorrhage
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DOI：
10.1007/s00701-014-2334-z
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发表时间：
2015-03-01
影响因子：
2.4
通讯作者：
Schmidt, Nils Ole
中科院分区：
文献类型：
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作者：
Czorlich, Patrick;Ricklefs, Franz;Schmidt, Nils Ole
估计蛛网膜下腔出血（SAH）的病死率（CFR）和慢性脑积水（CHC）发展的可靠预后工具尚未明确。为探讨Fisher、Graeb和LeRoux评分对SAH患者预后的实用性和可靠性，回顾性分析了206例SAH患者CFR和CHC的预测价值。评估临床数据，并使用Fisher、Graeb和LeRoux评分进行分级。CFR为17.0%，与较高的年龄、较高的Hunt & Hess（H&H）分级、较低的入院时格拉斯哥昏迷评分（GCS）以及较高的Fisher、Graeb和LeRoux评分相关（p < 0.001）。有19.9%的CHC需要永久性脑脊液分流术。低初始GCS（p = 0.003）、高H&H（p < 0.001）、脑内血肿（p = 0.003）、高Fisher（p = 0.047）、Graeb和LeRoux评分（p < 0.001）与存活患者中较高的脑室-腹腔分流（VPS）率相关。在多变量分析中，Graeb评分（比值比（OR）1.183 [1.027，1.363]，p = 0.020），LeRoux评分（OR 1.120 [1.013-1.239，p = 0.027），和H&H（OR 2.715 [1.496，4.927]，p = 0.001）的平均值Graeb或LeRoux评分改善了对分流依赖性的预测，并在部分CFR中改善了对蛛网膜下腔出血患者的预测，因此证实脑室内血液的范围和分布与SAH临床病程的相关性。
Reliable prognostic tools to estimate the case fatality rate (CFR) and the development of chronic hydrocephalus (CHC) in aneurysmal subarachnoid hemorrhage (SAH) are not well defined. This study aims to investigate the practicability and reliability of Fisher, Graeb, and LeRoux scores for SAH patient prognosis.A total of 206 patients with aneurysmal SAH were retrospectively analyzed in prediction of CFR and CHC. Clinical data was evaluated and grading was performed using Fisher, Graeb, and LeRoux scores. Univariate and multivariate analyses were performed to identify relevant predictive parameters.CFR was 17.0 % and was associated with higher age, higher Hunt & Hess (H&H) grade, lower Glasgow Coma Scale (GCS) at admission, as well as a higher Fisher, Graeb, and LeRoux score (p < 0.001). There were 19.9 % that developed CHC requiring permanent cerebrospinal fluid diversion. Low initial GCS (p = 0.003), high H&H (p < 0.001), intracerebral hematoma (p = 0.003), high Fisher (p = 0.047), Graeb and LeRoux scores (p < 0.001) were associated with a higher rate of ventricular-peritoneal shunting (VPS) in surviving patients. In multivariate analyses, Graeb score (odds ratio (OR) 1.183 [1.027, 1.363], p = 0.020), LeRoux score (OR 1.120 [1.013-1.239, p = 0.027), and H&H (OR 2.715 [1.496, 4.927], p = 0.001) remained independent prognostic factors for VPS.Graeb or LeRoux scores improve the prediction of shunt dependency and in parts of CFR in aneurysmal SAH patients therefore confirming the relevance of the extent and distribution of intraventricular blood for the clinical course in SAH.