Clinical features of subarachnoid hemorrhage in patients with positive cancer history
Clinical features of subarachnoid hemorrhage in patients with positive cancer history
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DOI：
10.1007/s11060-016-2085-1
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发表时间：
2016-05-01
影响因子：
3.9
通讯作者：
Tominaga, Teiji
中科院分区：
文献类型：
--
作者：
Shibahara, Ichiyo;Watanabe, Takashi;Tominaga, Teiji
癌症治疗的进步大大增加了长期幸存者的数量。生存期延长会增加合并症风险，但关于癌症病史如何改变后续疾病的临床结果的研究很少。本研究旨在调查阳性癌症史是否影响蛛网膜下腔出血（SAH）后的临床结果。我们回顾性地回顾了 2008 年 1 月至 2014 年 3 月期间入院的连续 SAH 患者。比较了有和无癌症史的 SAH 患者的病史、已知的 SAH 危险因素和结果。 498例SAH患者中，55例有癌症史，438例无癌症史，5例癌症史不明。与无癌症史的 SAH 患者相比，有癌症史的 SAH 患者的 Hunt & Hess 分级较差（P = 0.021），出院时改良 Rankin 量表（mRS）评分较差（P < 0.001）。调整年龄、性别、改良 Fisher、既往 SAH、高血压病史、当前吸烟状况和当前饮酒量后，阳性癌症史仍然是较差 mRS0-6 [比值比 (OR) = 2.25，95% 置信区间 (CI) 1.28-3.94] 和 mRS6（OR = 2.74，95% CI 1.40-5.37）的独立危险因素。此外，根据年龄、性别和改良 Fisher 量表调整的 Hunt & Hess 分级进行分层分析，较差 mRS0-6 的 OR 为 2.12 (95% CI 0.89-5.05)，mRS6 的 OR 为 3.68 (95% CI 1.35-10.04)。在根据人口因素、SAH 的经典危险因素和 Hunt & Hess 分级对患者进行调整后，既往癌症史是 SAH 功能结果不佳的危险因素。
Advances in cancer treatment have dramatically increased long-term survivors. Prolonged survival increases comorbidity risk, but there is a paucity of studies on how cancer history alters clinical outcomes from subsequent diseases. This study aims to investigate whether positive cancer history influences clinical outcome following subarachnoid hemorrhage (SAH). We retrospectively reviewed consecutive SAH patients admitted between January 2008 and March 2014. Medical histories, known SAH risk factors, and outcome were compared between SAH patients with and without cancer history. Out of the 498 SAH patients, 55 cases had cancer history, 438 cases had no cancer history and 5 cases had an unknown cancer history. Compared with SAH patients without cancer history, those with cancer history had poorer Hunt & Hess grade at SAH presentation (P = 0.021), and poorer modified Rankin Scale (mRS) score at discharge (P < 0.001). After adjustment for age, sex, modified Fisher, previous SAH, history of hypertension, current smoking status, and current alcohol consumption, positive cancer history remained an independent risk factor for poorer mRS0-6 [odds ratio (OR) = 2.25, 95 % confidence interval (CI) 1.28-3.94] and mRS6 (OR = 2.74, 95 % CI 1.40-5.37). Furthermore, stratified analysis by Hunt & Hess grade adjusted by age, sex, and modified Fisher scale, OR of poorer mRS0-6 was 2.12 (95 % CI 0.89-5.05) and OR of mRS6 was 3.68 (95 % CI 1.35-10.04). After adjustment of patients for demographic factors, classical risk factors for SAH and Hunt & Hess grade, previous cancer history is a risk factor for the poor functional outcome of SAH.