New risk score of the early period after spontaneous subarachnoid hemorrhage: For the prediction of delayed cerebral ischemia
New risk score of the early period after spontaneous subarachnoid hemorrhage: For the prediction of delayed cerebral ischemia
复制标题
DOI：
10.1111/cns.13202
复制
发表时间：
2019-08-12
影响因子：
5.5
通讯作者：
Chen, Sheng
中科院分区：
文献类型：
--
作者：
Fang, Yuan-Jian;Mei, Shu-Hao;Chen, Sheng
背景与目的本研究的目的是通过关注动脉瘤性蛛网膜下腔出血（aSAH）后的早期变化，确定延迟性脑缺血（DCI）的早期预测因素，并建立风险分层评分。方法回顾性分析2014 ~ 2015年aSAH患者资料。将aSAH后72小时内的危险因素纳入单变量和多变量logistic回归分析，筛选DCI的独立预测因子，设计风险分层评分。结果分析702例aSAH患者；在最终的多变量分析中保留了四个预测因子：世界神经外科学会联合会量表（WFNS; OR = 4.057, P < 0.001）、改良Fisher量表（mFS; OR = 2.623, P < 0.001）、蛛网膜下腔出血早期脑水肿评分（SEBES; OR = 1.539, P = 0.036）和脑室内出血（IVH; OR = 1.932, P = 0.002）。根据回归系数，我们建立了0 ~ 7的风险分层评分（WFNS = 3, mFS = 2, SEBES = 1, IVH = 1）。新评分曲线下面积（0.785）显著高于其他评分（P < 0.001）。结论早期DCI评分为预测aSAH后早期72h DCI提供了一种实用的方法。
Background and Purpose The aim of this study is to identify the early predictors for delayed cerebral ischemia (DCI) and develop a risk stratification score by focusing on the early change after aneurysmal subarachnoid hemorrhage (aSAH). Methods The study retrospectively reviewed aSAH patients between 2014 and 2015. Risk factors within 72 hours after aSAH were included into univariable and multivariable logistic regression analysis to screen the independent predictors for DCI and to design a risk stratification score. Results We analyzed 702 aSAH patients; four predictors were retained from the final multivariable analysis: World Federation of Neurosurgical Societies scale (WFNS; OR = 4.057, P < .001), modified Fisher Scale (mFS; OR = 2.623, P < .001), Subarachnoid Hemorrhage Early Brain Edema Score (SEBES; OR = 1.539, P = .036), and intraventricular hemorrhage (IVH; OR = 1.932, P = .002). According to the regression coefficient, we created a risk stratification score ranging from 0 to 7 (WFNS = 3, mFS = 2, SEBES = 1, and IVH = 1). The new score showed a significantly higher area under curve (0.785) compared with other scores (P < .001). Conclusion The early DCI score provides a practical method at the early 72 hours after aSAH to predict DCI.