Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective cohort studies
Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective cohort studies
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DOI：
10.1016/s1474-4422(13)70263-1
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发表时间：
2014-01-01
期刊：
影响因子：
48
通讯作者：
Algra, Ale
中科院分区：
文献类型：
--
作者：
Greving, Jacoba P.;Wermer, Marieke J. H.;Algra, Ale
背景：由于目前对偶发颅内囊状动脉瘤的自然病史的了解有限，是否治疗的决定很复杂。我们结合前瞻性队列研究的个体患者数据，确定动脉瘤破裂的预测因素，并构建风险预测图，根据危险因素状态估计5年动脉瘤破裂风险。方法：我们对6项以蛛网膜下腔出血为结局的前瞻性队列研究中8382名参与者的个体患者数据进行了系统回顾和汇总分析。我们用Kaplan-Meier曲线分析了累积破裂率，并用Cox比例风险回归分析评估了预测因子。在29166人年的随访中，230例患者发生破裂。观察到动脉瘤破裂的平均1年风险为1.4% (95% CI 1.1-1.6)， 5年风险为3.4%（2.9-4.0）。预测因素包括年龄、高血压、蛛网膜下腔出血史、动脉瘤大小、动脉瘤位置和地理区域。在除芬兰以外的北美和欧洲国家的研究人群中，估计动脉瘤破裂的5年绝对风险范围从70岁以下无血管危险因素的小型（< 7 mm）颈内动脉瘤患者的0.25%到70岁及以上有高血压、蛛网膜下腔出血史和巨大（bbb20 mm）后循环动脉瘤患者的15%以上。与除芬兰以外的北美和欧洲国家的人口相比，芬兰人动脉瘤破裂的风险增加了3.6倍，日本人的风险增加了2.8倍。分期评分是预测偶发颅内动脉瘤破裂风险的一种简便易行的方法。
Background The decision of whether to treat incidental intracranial saccular aneurysms is complicated by limitations in current knowledge of their natural history. We combined individual patient data from prospective cohort studies to determine predictors of aneurysm rupture and to construct a risk prediction chart to estimate 5-year aneurysm rupture risk by risk factor status.Methods We did a systematic review and pooled analysis of individual patient data from 8382 participants in six prospective cohort studies with subarachnoid haemorrhage as outcome. We analysed cumulative rupture rates with Kaplan-Meier curves and assessed predictors with Cox proportional-hazard regression analysis.Findings Rupture occurred in 230 patients during 29166 person-years of follow-up. The mean observed 1-year risk of aneurysm rupture was 1.4% (95% CI 1.1-1.6) and the 5-year risk was 3.4% (2.9-4.0). Predictors were age, hypertension, history of subarachnoid haemorrhage, aneurysm size, aneurysm location, and geographical region. In study populations from North America and European countries other than Finland, the estimated 5-year absolute risk of aneurysm rupture ranged from 0.25% in individuals younger than 70 years without vascular risk factors with a small-sized (< 7 mm) internal carotid artery aneurysm, to more than 15% in patients aged 70 years or older with hypertension, a history of subarachnoid haemorrhage, and a giant-sized (> 20 mm) posterior circulation aneurysm. By comparison with populations from North America and European countries other than Finland, Finnish people had a 3.6-times increased risk of aneurysm rupture and Japanese people a 2.8-times increased risk.Interpretation The PHASES score is an easily applicable aid for prediction of the risk of rupture of incidental intracranial aneurysms.