Early blood-brain barrier dysfunction predicts neurological outcome following aneurysmal subarachnoid hemorrhage
Early blood-brain barrier dysfunction predicts neurological outcome following aneurysmal subarachnoid hemorrhage
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DOI：
10.1016/j.ebiom.2019.04.054
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发表时间：
2019-05-01
期刊：
影响因子：
11.1
通讯作者：
Friedman, Alon
中科院分区：
文献类型：
--
作者：
Lublinsky, Svetlana;Major, Sebastian;Friedman, Alon
背景：蛛网膜下腔出血（aSAH）后疾病进展和迟发性神经系统并发症很常见。我们探讨了定量血脑屏障（BBB）成像的潜力，以预测疾病进展和神经outcome.Methods：数据收集的一部分，合作研究脑损伤去极化（COSBID）。我们回顾性分析了124例aSAH患者在首次出血后4个时间点（24-48小时、6-8天、12-15天和6-12个月）扫描的盲法和半自动磁共振图像。测量明显病理和/或BBB功能障碍（BBBD）、蛛网膜下腔和侧脑室的脑体积。入院时采用世界神经外科学会联合会和Rosen-Macdonald评分评估神经功能状态。使用扩展的格拉斯哥结局量表和病程（根据连续扫描中成像检测到的正常脑组织损失，进行性或非进行性）评估>= 6个月时的结局。逻辑回归用于定义最佳预测结果的生物标志物。接受者操作特征分析进行评估的准确性结果predictionmodels.Findings：在本队列中，63%的患者进行性和37%的非进展性疾病的过程。进展性病程与月时更差的结局相关（敏感性为98%，特异性为97%）。在入院后24-48 h病程进展的患者中，BBBD的脑体积显著更大（2.23（1.23-3.17）倍，中位数95%CI），并在所有时间点持续存在。BBB破坏的体素变得病态的可能性最高的距离是
Background: Disease progression and delayed neurological complications are common after aneurysmal subarachnoid hemorrhage (aSAH). We explored the potential of quantitative blood-brain barrier (BBB) imaging to predict disease progression and neurological outcome.Methods: Data were collected as part of the Co-Operative Studies of Brain Injury Depolarizations (COSBID). We analyzed retrospectively, blinded and semi-automatically magnetic resonance images from 124 aSAH patients scanned at 4 time points (24-48 h, 6-8 days, 12-15 days and 6-12 months) after the initial hemorrhage. Volume of brain with apparent pathology and/or BBB dysfunction (BBBD), subarachnoid space and lateral ventricles were measured. Neurological status on admission was assessed using the World Federation of Neurosurgical Societies and Rosen-Macdonald scores. Outcome at >= 6 months was assessed using the extended Glasgow outcome scale and disease course (progressive or non-progressive based on imaging-detected loss of normal brain tissue in consecutive scans). Logistic regression was used to define biomarkers that best predict outcomes. Receiver operating characteristic analysis was performed to assess accuracy of outcome prediction models.Findings: In the present cohort, 63% of patients had progressive and 37% non-progressive disease course. Progressive course was associated with worse outcome at months (sensitivity of 98% and specificity of 97%). Brain volume with BBBD was significantly larger in patients with progressive course already 24-48 h after admission (2.23 (1.23-3.17) folds, median with 95%CI), and persisted at all time points. The highest probability of a BBB-disrupted voxel to become pathological was found at a distance of