Yarlagadda Sirisha, Rajendran Pam, Miss Jacob C, Banki Nader M, Kopelnik Alexander, Wu Alan H B, Ko Nerissa, Gelb Adrian W, Lawton Michael T, Smith Wade S, Young William L, Zaroff Jonathan G
Department of Medicine, University of California San Francisco, San Francisco, CA 94143-0124, USA.
Neurocrit Care. 2006;5(2):102-7. doi: 10.1385/NCC:5:2:102.
Whether cardiac dysfunction contributes to morbidity and mortality after subarachnoid hemorrhage (SAH) remains controversial. The objective of this study was to test the hypothesis that cardiovascular abnormalities are independently related to in-patient mortality after SAH.
This was a prospective cohort study of patients with aneurysmal SAH. Heart rate and blood pressure were measured, a blood sample was obtained, and echocardiography was performed on three study days, starting as soon after admission as possible. The cardiovascular predictor variables were heart rate, systolic blood pressure (SBP), cardiac troponin I (cTi) level, B-type natriuretic peptide (BNP) level, and left ventricular ejection fraction. The primary outcome measure was in-patient mortality. The association between each predictor variable and mortality was quantified by multivariate logistic regression, including relevant covariates and reporting odds ratios (OR) and 95% confidence intervals (CI).
The study included 300 patients. An initial BNP level greater than 600 pg/mL was markedly associated with death (OR 37.7, p < 0.001). On the third study day (9.1 +/- 4.1 days after SAH symptom onset), a cTi level greater than 0.3 mg/L (OR 7.6, p = 0.002), a heart rate of 100 bpm or greater (OR 4.9, p = 0.009), and a SBP less than 130 mmHg (OR 6.7, p = 0.007) were significantly associated with death.
Cardiovascular abnormalities are independent predictors of in-patient mortality after SAH. Though these effects may be explained by a reduction in cerebral perfusion pressure or other mechanisms, further research is required to determine whether or not they are causal in nature.
心脏功能障碍是否会导致蛛网膜下腔出血（SAH）后的发病率和死亡率仍存在争议。本研究的目的是检验心血管异常与SAH后住院死亡率独立相关这一假设。
这是一项对动脉瘤性SAH患者的前瞻性队列研究。在入院后尽可能早的时间开始，于三个研究日测量心率和血压、采集血样并进行超声心动图检查。心血管预测变量包括心率、收缩压（SBP）、心肌肌钙蛋白I（cTi）水平、B型利钠肽（BNP）水平和左心室射血分数。主要结局指标是住院死亡率。通过多因素逻辑回归对每个预测变量与死亡率之间的关联进行量化，包括相关协变量，并报告比值比（OR）和95%置信区间（CI）。
该研究纳入了300例患者。初始BNP水平大于600 pg/mL与死亡显著相关（OR 37.7，p < 0.001）。在第三个研究日（SAH症状发作后9.1±4.1天），cTi水平大于0.3 mg/L（OR 7.6，p = 0.002）、心率100次/分钟或更高（OR 4.9，p = 0.009）以及SBP低于130 mmHg（OR 6.7，p = 0.007）与死亡显著相关。
心血管异常是SAH后住院死亡率的独立预测因素。尽管这些影响可能由脑灌注压降低或其他机制解释，但需要进一步研究以确定它们是否具有因果关系。
