Loss of consciousness at ictus and/or poor World Federation of Neurosurgical Societies grade on admission reflects the impact of EBI and predicts poor outcome in patients with SAH.
Loss of consciousness at ictus and/or poor World Federation of Neurosurgical Societies grade on admission reflects the impact of EBI and predicts poor outcome in patients with SAH.
复制标题
DOI：
10.25259/sni_551_2019
复制
发表时间：
2020-01-01
影响因子：
--
通讯作者：
Yoshida, Kazunari
中科院分区：
文献类型：
--
作者：
Takahashi, Satoshi;Akiyama, Takenori;Yoshida, Kazunari
背景：有许多评分和标志物可预测蛛网膜下腔出血（SAH）患者的不良结局。然而，参数，可以预测SAH患者的结果具有较高的特异性和敏感性，这可以确定在早期发作后状态，并利用作为早期脑损伤（EBI）的临床标志物尚未确定到目前为止。方法：39例SAH由于囊性颅内动脉瘤破裂进行了审查。我们回顾性分析了患者的基线特征和患者结局之间的关系，以确定可以预测早期发作后状态患者结局的参数。在单因素分析中，年龄较大（>65岁），发作时意识丧失（EEG），初始世界神经外科学会联合会（WFNS）分级差（3-5级），迟发性脑缺血（DCI）与预后差（GOS 1-3）相关。统计学分析显示，与单独的阵发性发作或初始WFNS分级差（3-5）相比，阵发性发作和/或初始WFNS分级差（3 - 5）的组合是更有力的结局替代标志物（OR 15. 2 [95% CI 3. 1 - 75. 5]）。多因素Logistic回归分析显示，年龄较大、合并阵发性发作和/或初始WFNS分级差、DCI与不良结局独立相关。结论：合并阵发性发作和/或初始WFNS分级差（3-5级）反映了EBI的影响，是SAH患者预后不良的一个有用的替代指标，与患者的年龄和DCI状态无关。
BACKGROUND: There are many scores and markers that predict poor outcome in patients with subarachnoid hemorrhage (SAH). However, parameters that can predict outcomes in patients with SAH with high specificity and sensitivity, which can be identified in the early postictal state and utilized as a clinical marker of early brain injury (EBI) have not been identified so far.METHODS: Thirty-nine patients with SAH due to a saccular intracranial aneurysm rupture were reviewed. We retrospectively analyzed the relationships between patients' baseline characteristics and patients' outcomes to identify parameters that could predict patient outcomes in the early postictal state.RESULTS: In the univariate analysis, older age (>65), loss of consciousness (LOC) at ictus, poor initial World Federation of Neurosurgical Societies (WFNS) grade (3-5), and delayed cerebral ischemia (DCI) were associated with poor outcome (GOS 1-3). Statistical analyses revealed that combined LOC at ictus and/or poor initial WFNS grade (3-5) was a more powerful surrogate marker of outcome (OR 15.2 [95% CI 3.1-75.5]) than either LOC at ictus or the poor initial WFNS grade (3-5) alone. Multivariate logistic regression analyses revealed that older age, combined LOC at ictus and/or poor initial WFNS grade, and DCI were independently associated with poor outcome.CONCLUSION: Combined LOC at ictus and/or poor initial WFNS grade (3-5) reflects the impact of EBI and was a useful surrogate marker of poor prognosis in SAH patients, independent of patients' age and state of DCI.