Institute of Psychiatry, King's College London, London, United Kingdom.
Neurosurgery. 2010 Apr;66(4):772-83. doi: 10.1227/01.NEU.0000367548.63164.B2.
Patients with subarachnoid hemorrhage (SAH) are younger than typical stroke patients. Poor psychosocial outcome after SAH therefore leads to a disproportionately high impact on patients, relatives, and society. Addressing this problem requires an understanding of what causes poor psychosocial outcome. Numerous studies have examined potential predictors but produced conflicting results. We aim to resolve this uncertainty about the potential value of individual predictors by conducting a meta-analysis. This approach allows us to quantitatively combine the findings from all relevant studies to identify promising predictors of psychosocial outcome and determine the strength with which those predictors are associated with measures of psychosocial health.
Psychosocial health was measured by health-related quality of life (HRQOL). We included in our analysis those predictors that were most frequently examined in this context, namely patient age, sex, neurologic state at the time of hospital admission, bleed severity, physical disability, cognitive impairment, and time between ictus and psychosocial assessment.
Only 1 of the traditional variables, physical disability, had any notable affect on HRQOL. Therefore, the cause of most HRQOL impairment after SAH remains unknown. The situation is even worse for mental HRQOL, an area that is often significantly affected in SAH patients. Here, 90% of the variance remains unexplained by traditional predictors.
Studies need to turn to new factors to account for poor patient outcome.
蛛网膜下腔出血（SAH）患者比典型的中风患者年轻。因此，SAH 后较差的社会心理预后会对患者、亲属和社会造成不成比例的重大影响。解决这个问题需要了解导致较差社会心理预后的原因。许多研究都检查了潜在的预测因素，但得出了相互矛盾的结果。我们旨在通过进行荟萃分析来解决这些关于个体预测因素潜在价值的不确定性。这种方法使我们能够定量地结合所有相关研究的结果，以确定有希望的社会心理预后预测因素，并确定这些预测因素与社会心理健康测量结果的关联强度。
社会心理健康通过健康相关生活质量（HRQOL）来衡量。我们将在这方面最常被检查的预测因素纳入我们的分析，即患者年龄、性别、入院时的神经状态、出血严重程度、身体残疾、认知障碍以及中风与社会心理评估之间的时间间隔。
只有传统变量之一的身体残疾对 HRQOL 有任何显著影响。因此，SAH 后大多数 HRQOL 受损的原因仍不清楚。对于精神 HRQOL 来说情况更糟，这是 SAH 患者经常受到严重影响的一个领域。在这里，90%的方差无法用传统的预测因素来解释。
研究需要转向新的因素来解释患者的不良预后。
