Effect of acute physiologic derangements on outcome after subarachnoid hemorrhage
Effect of acute physiologic derangements on outcome after subarachnoid hemorrhage
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DOI：
10.1097/01.ccm.0000114830.48833.8a
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发表时间：
2004-03-01
影响因子：
8.8
通讯作者：
Mayer, SA
中科院分区：
文献类型：
--
作者：
Claassen, J;Vu, A;Mayer, SA
目标。目的：确定蛛网膜下腔出血(SAH)后急性生理紊乱对预后的影响，并设计总结这些异常的综合评分。设计：前瞻性观察研究。地点：三级护理学术中心的神经科学重症监护病房。患者：连续队列413名SAH患者，发病3天内入院，采用3个月改良Rankin量表评分。干预：无。结果。在入院24小时内评估的20个生理变量中，有4个与3个月后死亡或严重残疾(改良Rankin量表评分，4-6)独立相关：动脉-肺泡梯度；125 mm Hg(优势比[OR]，4.5；95%可信区间[CI]，2.7-7.6)，血清碳酸氢盐180 mg/dL(OR，2.8；95%CI，1.6-4.8)，平均动脉压130 mm Hg(OR，1.7；95%CI，1.0-2.9)。根据它们对预后的比例贡献，我们通过为异常发现分配以下权重来构建SAH生理性错乱评分(SAH-PDS；范围0-8)：动脉-肺泡梯度3分；碳酸氢盐2分；葡萄糖2分；平均动脉压1分。在控制了死亡或严重残疾的已知预测因素(年龄、入院神经状态、意识丧失、动脉瘤大小、脑室内出血和再出血)后，SAH生理性错乱评分与不良预后独立相关(OR，每增加一分，OR为1.3；95%CI，1.1-1.6)。相比之下，全身炎症反应综合征评分和急性生理学和慢性健康评估II生理学子评分并未增加模型的预测值。针对低氧血症、代谢性酸中毒、高血糖和心血管不稳定的急性干预可能会改善SAH患者的预后。SAH生理性紊乱评分可能有助于快速量化急性SAH中重要生理性紊乱的严重程度。
Objective. To determine the effect that acute physiologic derangements have on outcome after subarachnoid hemorrhage (SAH) and to design a composite score summarizing these abnormalities.Design: Prospective observational study.Setting: Neuroscience intensive care unit in a tertiary care academic center.Patients: Consecutive cohort of 413 patients with SAH admitted within 3 days of SAH onset with 3-month modified Rankin Scale scores.Interventions: None.Results. Among 20 physiologic variables assessed within 24 hirs of admission, four were independently associated with death or severe disability (modified Rankin Scale score, 4-6) at 3 months in a multivariate analysis: arterio-alveolar gradient of >125 mm Hg (odds ratio [OR], 4.5; 95% confidence interval [CI], 2.7-7.6), serum bicarbonate of 180 mg/dL (OR, 2.8; 95% CI, 1.6-4.8), and mean arterial pressure of 130 mm Hg (OR, 1.7; 95% CI, 1.0-2.9). Based on their proportional contribution to outcome, we constructed the SAH Physiologic Derangement Score (SAH-PDS; range, 0-8) by assigning the following weights for abnormal findings: arterio-alveolar gradient, 3 points; bicarbonate, 2 points; glucose, 2 points; and mean arterial pressure, 1 point. After controlling for known predictors of death or severe disability (age, admission neurologic status, loss of consciousness, aneurysm size, intraventricular hemorrhage, and re-bleeding), the SAH Physiologic Derangement Score was independently associated with poor outcome (OR, 1.3 for each point increase; 95% CI, 1.1-1.6). By contrast, the systemic inflammatory response syndrome score and the Acute Physiology and Chronic Health Evaluation II physiologic subscore did not add predictive value to the model.Conclusion. Acute interventions specifically targeting hypoxemia, metabolic acidosis, hyperglycemia, and cardiovascular instability may improve the outcome of SAH patients. The SAH Physiologic Derangement Score may prove useful for rapidly quantifying the severity of important physiologic derangements in acute SAH.