Effects of Pre-Existing Comorbidities on Outcomes in Patients with Chronic Subdural Hematoma
Effects of Pre-Existing Comorbidities on Outcomes in Patients with Chronic Subdural Hematoma
复制标题
DOI：
10.1016/j.wneu.2018.10.176
复制
发表时间：
2019-02-01
影响因子：
2
通讯作者：
Matsumae, Mitsunori
中科院分区：
文献类型：
--
作者：
Atsumi, Hideki;Sorimachi, Takatoshi;Matsumae, Mitsunori
目的：近年来随着社会老龄化的发展，慢性硬膜下血肿（CSDH）患者在发病前出现合并症和/或日常生活活动（ADL）受损的人数有所增加。本研究的目的是通过比较病前ADL和出院时ADL来评估ADL恶化，并调查预先存在的共病相关临床因素对结局的影响。方法：回顾性研究了2006年至2016年收治的570例CSDH患者。通过多变量分析确定与结局相关的临床因素，包括既存的合并症。改良兰金量表（mRS）的变化，使用5个联合类别的mRS评分0/1，2，3/4，5，和死亡被用于评估ADL.Results：在570例患者中，390例（68.4%）预先存在的合并症和120（21.1%）表现出病前受损的ADL（mRS评分2和更差）。考虑到先前存在的ADL受损，92例患者（16.1%）在CSDH后ADL恶化，而173例患者（30.4%）在出院时发现ADL受损。多变量分析显示，与ADL恶化相关的合并症为血液透析和慢性心力衰竭。抗血栓药物用于心血管疾病是急性-慢性硬膜下血肿的预测因子，这是ADL恶化和手术并发症发生的唯一共同预测因子。结论：在CSDH患者中，与结局相关的预先存在的合并症相关因素为血液透析、慢性心力衰竭和抗血栓药物的使用。急性加慢性硬膜下血肿患者同时存在上述因素，应视为高危人群。
OBJECTIVE: The number of patients with chronic subdural hematoma (CSDH) showing comorbidities and/or impaired activities of daily living (ADL) before the onset of CSDH has increased with the recent aging of society. The purposes of this study were to evaluate ADL worsening by comparing premorbid ADL and ADL at discharge and to investigate the effects of pre-existing comorbidity-related clinical factors on the outcomes.METHODS: A total of 570 patients with CSDH admitted from 2006 to 2016 were studied retrospectively. Clinical factors, including pre-existing comorbidities, related to outcomes were identified by multivariate analysis. A variation of the modified Rankin Scale (mRS) using 5 united categories of mRS scores 0/1, 2, 3/4, 5, and dead was used for evaluation of ADL.RESULTS: Of 570 patients, 390 (68.4%) had pre-existing comorbidities and 120 (21.1%) showed premorbid impaired ADL (mRS scores 2 and worse). Considering preexisting impaired ADL, ADL deteriorated after CSDH in 92 patients (16.1%), whereas ADL impairment at discharge was found in 173 patients (30.4%). Comorbidities related to ADL deterioration on multivariate analysis were hemodialysis and chronic heart failure. Antithrombotic use for cardiovascular diseases was a predictor of acute-onchronic subdural hematoma, which was the sole common predictor for ADL deterioration and the occurrence of surgical complications.CONCLUSIONS: In patients with CSDH, pre-existing comorbidity-linked factors related to outcomes were hemodialysis, chronic heart failure, and antithrombotic use. Patients with acute-on-chronic subdural hematoma with these factors should be regarded as a high-risk group.