Pereira Ana R, Sanchez-Peña Paola, Biondi Alessandra, Sourour Nader, Boch Anne L, Colonne Chantal, Lejean Lise, Abdennour Lamine, Puybasset Louis
Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie-Paris 6 University, Paris, France.
Neurocrit Care. 2007;7(1):18-26. doi: 10.1007/s12028-007-0053-5.
To describe features in patients admitted to the intensive care unit (ICU) for poor-grade aneurysmal subarachnoid hemorrhage (SAH) and to identify predictors of 12-month outcome.
We conducted a controlled observational study of 51 consecutive patients treated with endovascular coiling within 96 h of rupture for poor-grade aneurysmal SAH (20 men and 31 women, age 54 +/- 12 years). We recorded co-morbidities; initial severity; aneurysm location; occurrence of acute hydrocephalus, initial seizures, and/or neurogenic lung edema; troponin values, Fisher grade; computed tomography (CT) findings; treatment intensity; and occurrence of vasospasm. The brain injury marker S100B was assayed daily over the first 8 days. Glasgow Outcome Scores (GOS) were recorded at ICU discharge, at 6 and 12 months. The main outcome criterion was the 1-year GOS score, which we used to classify patients as having a poor outcome (GOS 1-3) or a good outcome (GOS 4-5).
Overall, clinical status after 1 year was very good (GOS 5) in 41% of patients and good (GOS 4) in 16%. Neither baseline characteristics nor interventions differed significantly between patients with good outcome (GOS 4-5) and those with poor outcome (GOS 1-3). Persistent intracranial pressure elevation and higher mean 8-day S100B value significantly and independently predicted the 1-year GOS outcome (P = 0.008 and P = 0.001, respectively).
Patients in poor clinical condition after SAH have more than a 50:50 chance of a favorable outcome after 1 year. High mean 8-day S100B value and persistent intracranial hypertension predict a poor outcome (GOS 1-3) after 1 year.
描述因低级别动脉瘤性蛛网膜下腔出血（SAH）入住重症监护病房（ICU）患者的特征，并确定12个月预后的预测因素。
我们对51例在破裂后96小时内接受血管内栓塞治疗的低级别动脉瘤性SAH患者进行了对照观察研究（20例男性和31例女性，年龄54±12岁）。我们记录了合并症；初始严重程度；动脉瘤位置；急性脑积水、初始癫痫发作和/或神经源性肺水肿的发生情况；肌钙蛋白值、Fisher分级；计算机断层扫描（CT）结果；治疗强度；以及血管痉挛的发生情况。在最初8天内每天检测脑损伤标志物S100B。在ICU出院时、6个月和12个月时记录格拉斯哥预后评分（GOS）。主要预后标准是1年GOS评分，我们用它将患者分为预后不良（GOS 1-3）或预后良好（GOS 4-5）。
总体而言，1年后41%的患者临床状态非常好（GOS 5），16%的患者临床状态良好（GOS 4）。预后良好（GOS 4-5）的患者与预后不良（GOS 1-3）的患者在基线特征和干预措施方面均无显著差异。持续颅内压升高和较高的8天平均S100B值显著且独立地预测了1年GOS预后（分别为P = 0.008和P = 0.001）。
SAH后临床状况较差的患者1年后有超过50%的机会获得良好预后。8天平均S100B值高和持续性颅内高压预示1年后预后不良（GOS 1-3）。
