Starke Robert M, Komotar Ricardo J, Kim Grace H, Kellner Christopher P, Otten Marc L, Hahn David K, Michael Schmidt J, Sciacca Robert R, Mayer Stephan A, Sander Connolly E
Department of Neurology and Neurosurgery, Columbia University, 710 West 168th Street, New York, New York 10032, USA.
J Clin Neurosci. 2009 Jul;16(7):894-9. doi: 10.1016/j.jocn.2008.10.010. Epub 2009 Apr 16.
Although many scales attempt to predict outcome following aneurysmal subarachnoid hemorrhage (aSAH), none have achieved universal acceptance, and most scales in common use are not statistically derived. We propose a statistically validated scale for poor grade aSAH patients that combines the Hunt and Hess grades and the Glasgow Coma Scale (GCS) scores; we refer to this as the Poor Grade GCS (PGS). The GCS scores of 160 poor grade aSAH patients (Hunt and Hess Grades 4 and 5) were recorded throughout their hospital stay. Outcomes were assessed by the modified Rankin scale (mRS). Analysis of variance and the Chi-square test were used to guide an analysis of GCS breakpoints according to outcomes. Multivariable logistic regression analysis was used to assess the ability of the Hunt and Hess, GCS, World Federation of Neurological Surgeons Grading Scale, and the PGS to predict long-term outcome. Outcome analysis revealed significant breakpoints in admission GCS scores: PGS-A (GCS 10-12); PGS-B (GCS 8-9); PGS-C (GCS 5-7); PGS-D (GCS 3-4) (p<0.001). In surgical patients, 95.2% of PGS-A, 58.1% of PGS-B, 35.4% of PGS-C, and 28.6% of PGS-D had a favorable one-year outcome. When controlling for age, sex, and operation status, PGS was the only scale predictive of long-term outcome. The odds ratios (OR) for unfavorable outcome according to PGS admission scores (with PGS-A as the reference) were: PGS-B, OR=14.2 (95% CI 1.5-140.5); PGS-C, OR=38.5 (95% CI 4.2-340.0); and PGS-D, OR=63.4 (95% CI 5.6-707.1). In addition to PGS admission scores, an age of 70 or greater was a significant predictor of poor outcome with an OR of 7.5 (95% CI 1.8-30.7). No patients with a PGS-C or PGS-D over the age of 70 had a favorable long-term outcome. Therefore, elements of the Hunt and Hess and GCS can be combined into the PGS to predict long-term outcome in poor grade aSAH patients. However, patients with PGS-C and PGS-D over the age of 70 should be assessed carefully prior to definitive treatment.
尽管许多量表试图预测动脉瘤性蛛网膜下腔出血（aSAH）后的预后，但没有一个量表得到普遍认可，并且大多数常用量表并非基于统计学得出。我们提出了一种经过统计学验证的针对低级别aSAH患者的量表，该量表结合了Hunt和Hess分级以及格拉斯哥昏迷量表（GCS）评分；我们将其称为低级别GCS（PGS）。记录了160例低级别aSAH患者（Hunt和Hess分级为4级和5级）在整个住院期间的GCS评分。通过改良Rankin量表（mRS）评估预后。采用方差分析和卡方检验来指导根据预后对GCS断点进行分析。多变量逻辑回归分析用于评估Hunt和Hess分级、GCS、世界神经外科医师联合会分级量表以及PGS预测长期预后的能力。预后分析显示入院时GCS评分存在显著断点：PGS-A（GCS 10 - 12）；PGS-B（GCS 8 - 9）；PGS-C（GCS 5 - 7）；PGS-D（GCS 3 - 4）（p<0.0０1）。在接受手术的患者中，PGS-A组95.2%、PGS-B组58.1%、PGS-C组35.4%以及PGS-D组28.6%在一年后预后良好。在控制年龄、性别和手术状态后，PGS是唯一能预测长期预后的量表。根据PGS入院评分（以PGS-A为参照）得出的不良预后比值比（OR）为：PGS-B，OR = 14.2（95%CI 1.5 - 140.5）；PGS-C，OR = 38.5（95%CI 4.2 - 340.0）；PGS-D，OR = 63.4（95%CI 5.6 - 707.1）。除了PGS入院评分外，年龄70岁及以上是不良预后的显著预测因素，OR为7.5（95%CI 1.8 - 30.7）。没有70岁及以上的PGS-C或PGS-D患者有良好的长期预后。因此，Hunt和Hess分级以及GCS的要素可以合并到PGS中，以预测低级别aSAH患者的长期预后。然而，对于70岁及以上的PGS-C和PGS-D患者，在进行确定性治疗前应仔细评估。
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