Department of Anesthesiology and Critical Care, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
Anesthesiology. 2012 Dec;117(6):1289-99. doi: 10.1097/ALN.0b013e318267395b.
An increasing number of elderly patients are treated for aneurysmal subarachnoid hemorrhage. Given that elderly age is associated with both poor outcome and an increased risk of hydrocephalus, we sought to investigate the interaction between age and hydrocephalus in outcome prediction.
We enrolled 933 consecutive patients treated for subarachnoid hemorrhage between 2002 and 2010 and followed them for 1 yr after intensive care unit discharge. We first performed stepwise analyses to determine the relationship among neurologic events, elderly age (60 or more yr old), and 1-yr poor outcome (defined as Rankin 4-6). Within the most parsimonious model, we then tested for interaction between admission hydrocephalus and elderly age. Finally, we tested the association between age as a stratified variable and 1-yr poor outcome for each subgroup of patients with neurologic events.
24.1% (n=225) of subarachnoid hemorrhage patients were 60 yr old or more and 19.3% (n=180) had 1-yr poor outcomes. In the most parsimonious model (area under the receiver operating characteristic curve, 0.84; 95% CI: 0.82 to 0.88; P<0.001), elderly age and admission hydrocephalus were two independent predictors for 1-yr outcome (P<0.001 and P=0.004, respectively). Including the significant interaction between age and hydrocephalus (P=0.04) improved the model's outcome prediction (P=0.03), but elderly age was no longer a significant predictor. Finally, stratified age was associated with 1-yr poor outcome for hydrocephalus patients (P=0.007), but not for patients without hydrocephalus (P=0.87).
In this observational study, elderly age and admission hydrocephalus predicted poor outcome, but elderly age without hydrocephalus did not. An external validation, however, will be needed to generalize this finding.
越来越多的老年患者接受了颅内动脉瘤性蛛网膜下腔出血的治疗。鉴于老年与不良预后和脑积水风险增加相关，我们试图研究年龄与预后的相关性。
我们纳入了 2002 年至 2010 年间连续接受治疗的 933 例蛛网膜下腔出血患者，并在重症监护病房出院后随访 1 年。我们首先进行逐步分析，以确定神经事件、老年（60 岁或以上）和 1 年预后不良（定义为 Rankin 4-6）之间的关系。在最简洁的模型中，我们然后测试了入院时脑积水和老年年龄之间的相互作用。最后，我们测试了年龄作为分层变量与有神经事件的每个亚组患者的 1 年预后不良之间的关联。
24.1%（n=225）的蛛网膜下腔出血患者年龄在 60 岁或以上，19.3%（n=180）有 1 年预后不良。在最简洁的模型中（接收者操作特征曲线下面积，0.84；95%CI：0.82 至 0.88；P<0.001），老年和入院时脑积水是 1 年预后的两个独立预测因素（P<0.001 和 P=0.004）。包括年龄和脑积水之间的显著相互作用（P=0.04）提高了模型的预后预测（P=0.03），但老年不再是一个显著的预测因素。最后，分层年龄与脑积水患者的 1 年预后不良相关（P=0.007），但与无脑积水患者无关（P=0.87）。
在这项观察性研究中，老年和入院时的脑积水预测了不良预后，但没有脑积水的老年患者则不然。然而，需要进行外部验证才能推广这一发现。
