An Admission Bioclinical Score to Predict 1-Year Outcomes in Patients Undergoing Aneurysm Coiling
An Admission Bioclinical Score to Predict 1-Year Outcomes in Patients Undergoing Aneurysm Coiling
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DOI：
10.1161/strokeaha.111.638197
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发表时间：
2012-05-01
期刊：
影响因子：
8.3
通讯作者：
Puybasset, Louis
中科院分区：
文献类型：
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作者：
Degos, Vincent;Apfel, Christian C.;Puybasset, Louis
背景和目的-许多评分被用来预测蛛网膜下腔出血夹闭术后的结局，但是对于接受血管内治疗的患者没有评分。我们的目标是开发，比较，并验证一个预测评分1年的结果在患者与线圈蛛网膜下腔hemorrhages. Methods，我们研究了526例患者1年后，重症监护病房出院。我们开发了一种入院生物临床评分（ABC评分），将肌钙蛋白I和S100 β等生物标志物与格拉斯哥昏迷量表相结合。使用受试者工作特征曲线（95% CI），将ABC评分与推导队列中的格拉斯哥昏迷量表、世界神经外科学会联合会评分和Fisher评分进行比较，并在一个独立队列中进一步验证。（2003-2007年，n=368），多变量逻辑回归分析显示，只有格拉斯哥昏迷量表（P < 0.001）、高S100 β（P < 0.001）和高肌钙蛋白（P < 0.02）与1年死亡率独立相关。因此，整合肌钙蛋白、S100 β和格拉斯哥昏迷量表以得出ABC评分。在推导队列中，ABC评分达到0.82（0.77-0.88，P < 0.001）的受试者操作特征曲线，并且显著大于预测1年死亡率的格拉斯哥昏迷量表、世界神经外科学会联合会和Fisher评分的受试者操作特征曲线。在验证队列中（2008-2009年，n=158），ABC评分的受试者工作特征曲线为0.76（0.67-0.86，P < 0.001），在预测1年死亡率方面仍然上级其他3个评分。我们的研究提供了大量基于队列的证据，支持整合个体生物标志物和临床特征来预测结果。
Background and Purpose-A number of scores were developed to predict outcomes after clipping for subarachnoid hemorrhages, yet there is no score for patients undergoing endovascular treatment. Our goal was to develop, compare, and validate a predictive score for 1-year outcomes in patients with coiled subarachnoid hemorrhage.Methods-We studied 526 patients for 1 year after intensive care unit discharge. We developed an admission bioclinical score (ABC score), which integrated biomarkers such as troponin I and S100 beta, with the Glasgow Coma Scale. Using the receiver operating characteristic curve (95% CI), the ABC score was compared with the Glasgow Coma Scale, World Federation of Neurosurgical Societies score, and Fisher score in the derivation cohort and further validated in an independent cohort.Results-In the derivation cohort (from 2003-2007, n=368), multivariate logistic regression analysis showed that only Glasgow Coma Scale (P < 0.001), high S100 beta (P < 0.001), and high troponin (P < 0.02) were independently associated with 1-year mortality. Troponin, S100 beta, and Glasgow Coma Scale were thus integrated to derive the ABC score. In the derivation cohort, the ABC score reached an receiver operating characteristic curve of 0.82 (0.77-0.88, P < 0.001) and was significantly greater than the receiver operating characteristic curves of the Glasgow Coma Scale, World Federation of Neurosurgical Societies, and Fisher scores for predicting 1-year mortality. In the validation cohort (from 2008-2009, n=158), the ABC score's receiver operating characteristic curve of 0.76 (0.67-0.86, P < 0.001) remained superior to the 3 other scores for predicting 1-year mortality.Conclusions-The ABC score improves 1-year outcome prediction at admission for patients with coiled subarachnoid hemorrhage. Our study provides large cohort-based evidence supporting integration of individual biomarkers and clinical characteristics to predict outcomes.