Schuiling Wouter Jan, de Weerd Al W, Dennesen Paul J W, Algra Ale, Rinkel Gabriël J E
Department of Neurology and Clinical Neurophysiology, Medical Center Haaglanden, Westeinde Hospital, Haaglanden, The Netherlands.
Neurosurgery. 2005 Aug;57(2):230-6; discussion 230-6. doi: 10.1227/01.neu.0000166536.42876.9c.
Current prognosticators for patients with subarachnoid hemorrhage (SAH) do not take into account signs of extracerebral organ dysfunction. This may explain the only moderate predictive value of these prognosticators. We assessed the prognostic value of the simplified acute physiology score (SAPS) II in SAH patients.
In a retrospective cohort study of 148 consecutive SAH patients, we related the SAPS II calculated within 24 hours after admission to clinical and initial computed tomographic imaging characteristics using the Mann-Whitney U test. We compared the prognostic value of the SAPS II with that of the World Federation of Neurosurgical Surgeons score, the patient's age, and the amount of blood showing in computed tomographic imaging for the occurrence of delayed cerebral ischemia using Cox proportional hazards modeling or, for poor outcome (death or dependence), logistic regression modeling.
In the univariate analysis, the SAPS II was the strongest prognosticator; in the multivariate model, the SAPS II was the only independent predictor for outcome (odds ratio, 1.08; 95% confidence interval, 1.06-1.11]). Patients in the highest tertile of SAPS II had a significantly higher risk of poor outcome than those in the lowest tertile (odds ratio, 30.9; 95% confidence interval, 9.9-96.7]). The SAPS II was also the only independent predictor for the occurrence of delayed cerebral ischemia (hazard ratio, 1.020; 95% confidence interval, 1.002-1.039]).
The SAPS II is a useful and reliable prognosticator in SAH patients. This score may provide more information than specific SAH scales in predicting poor outcome or the occurrence of delayed cerebral ischemia in some circumstances.
目前蛛网膜下腔出血（SAH）患者的预后指标未考虑脑外器官功能障碍的体征。这可能解释了这些预后指标仅具有中等预测价值的原因。我们评估了简化急性生理学评分（SAPS）II在SAH患者中的预后价值。
在一项对148例连续SAH患者的回顾性队列研究中，我们使用Mann-Whitney U检验将入院后24小时内计算的SAPS II与临床和初始计算机断层扫描成像特征相关联。我们使用Cox比例风险模型或针对不良结局（死亡或依赖）的逻辑回归模型，比较了SAPS II与世界神经外科医师联合会评分、患者年龄以及计算机断层扫描成像中显示的出血量对迟发性脑缺血发生的预后价值。
在单变量分析中，SAPS II是最强的预后指标；在多变量模型中，SAPS II是结局的唯一独立预测指标（优势比，1.08；95%置信区间，1.06 - 1.11）。SAPS II最高三分位数的患者比最低三分位数的患者发生不良结局的风险显著更高（优势比，30.9；95%置信区间，9.9 - 96.7）。SAPS II也是迟发性脑缺血发生的唯一独立预测指标（风险比，1.020；95%置信区间，1.002 - 1.039）。
SAPS II在SAH患者中是一个有用且可靠的预后指标。在某些情况下，该评分在预测不良结局或迟发性脑缺血的发生方面可能比特定的SAH量表提供更多信息。
