Cerebral inflammatory response and predictors of admission clinical grade after aneurysmal subarachnoid hemorrhage.
Cerebral inflammatory response and predictors of admission clinical grade after aneurysmal subarachnoid hemorrhage.
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DOI：
10.1016/j.jocn.2009.09.003
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发表时间：
2010-01
影响因子：
2
通讯作者：
Badjatia, Neeraj
中科院分区：
文献类型：
--
作者：
Hanafy, Khalid A.;Stuart, R. Morgan;Fernandez, Luis;Schmidt, J. Michael;Claassen, Jan;Lee, Kiwon;Connolly, E. Sander;Mayer, Stephan A.;Badjatia, Neeraj
关键词：
入院临床分级不佳是动脉瘤性蛛网膜下腔出血 (aSAH) 后预后的最重要决定因素；然而，很少有人关注入院临床分级不良的独立预测因素。我们假设动脉瘤破裂时引发的脑炎症反应导致超早期脑损伤和入院临床分级较差。我们试图找出已知的导致脑炎症的因素以及与入院临床分级较差相关的脑功能障碍标志物。 1997 年至 2008 年间，我们的前瞻性数据库中连续登记了 850 名 SAH 患者。记录人口统计数据、生理参数以及血液的位置和体积。单变量分析后，将显着变量输入逻辑回归模型，以确定与较差入院临床分级（Hunt-Hess 4-5 级）的显着关联。入院分级不良的独立预测因素包括 SAH 总分 >15/30（比值比 [OR] 2.3，95% 置信区间 [CI] 1.5–3.6）、脑室内出血总分 >1/12（OR 3.1，95% CI 2.1–4.8）、动脉瘤大小 >10 mm（OR 1.7，95% CI） 1.1–2.6），体温≥38.3°C（OR 2.5，95% CI 1.1–5.4），高血糖>200 mg/dL（OR 2.7，95% CI 1.6–4.5）。在大量连续前瞻性入组的 SAH 患者中，动脉瘤破裂时的炎症反应（通过血红蛋白负荷的体积和位置、体温过高和葡萄糖代谢紊乱所反映）独立预测较差的入院 Hunt-Hess 分级。在超急性环境下减轻动脉瘤破裂炎症反应的策略可能会提高入院临床分级，从而改善预后。
Poor admission clinical grade is the most important determinant of outcome after aneurysmal subarachnoid hemorrhage (aSAH); however, little attention has been focused on independent predictors of poor admission clinical grade. We hypothesized that the cerebral inflammatory response initiated at the time of aneurysm rupture contributes to ultra-early brain injury and poor admission clinical grade. We sought to identify factors known to contribute to cerebral inflammation as well as markers of cerebral dysfunction that were associated with poor admission clinical grade. Between 1997 and 2008, 850 consecutive SAH patients were enrolled in our prospective database. Demographic data, physiological parameters, and location and volume of blood were recorded. After univariate analysis, significant variables were entered into a logistic regression model to identify significant associations with poor admission clinical grade (Hunt–Hess grade 4–5). Independent predictors of poor admission grade included a SAH sum score >15/30 (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.5–3.6), an intraventricular hemorrhage sum score >1/12 (OR 3.1, 95% CI 2.1–4.8), aneurysm size >10 mm (OR 1.7, 95% CI 1.1–2.6), body temperature ≥38.3°C (OR 2.5, 95% CI 1.1–5.4), and hyperglycemia >200 mg/dL (OR 2.7, 95% CI 1.6–4.5). In a large, consecutive series of prospectively enrolled patients with SAH, the inflammatory response at the time of aneurysm rupture, as reflected by the volume and location of the hemoglobin burden, hyperthermia, and perturbed glucose metabolism, independently predicts poor admission Hunt–Hess grade. Strategies for mitigating the inflammatory response to aneurysmal rupture in the hyper-acute setting may improve the admission clinical grade, which may in turn improve outcomes.
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影响因子：
4.8
作者：
Cahill, Julian;Calvert, John W.;Zhang, John H.
通讯作者：
Zhang, John H.
影响因子：
8.3
作者：
HIJDRA, A;VANGIJN, J;VANCREVEL, H
通讯作者：
VANCREVEL, H
影响因子：
4.1
作者：
VANGIJN, J;HIJDRA, A;VANCREVEL, H
通讯作者：
VANCREVEL, H
影响因子：
158.5
作者：
BRODERICK, JP;BROTT, T;MILLER, R
通讯作者：
MILLER, R
影响因子：
8.3
作者：
Claassen, J;Carhuapoma, JR;Mayer, SA
通讯作者：
Mayer, SA