蛛网膜下腔出血后迟发性脑缺血的早期预测：实用风险图表的制定和验证。
Early prediction of delayed cerebral ischemia after subarachnoid hemorrhage: development and validation of a practical risk chart.
机构信息
Department of Neurology and Neurosurgery, University Medical Center Utrecht, Room H02.128, PO Box 85500, 3508 GA Utrecht, The Netherlands.
出版信息
Stroke. 2013 May;44(5):1288-94. doi: 10.1161/STROKEAHA.113.001125. Epub 2013 Mar 19.
BACKGROUND AND PURPOSE
To develop and validate a risk chart for prediction of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage based on admission characteristics.
METHODS
For derivation of the risk chart, we studied data from 371 prospectively collected consecutive subarachnoid hemorrhage patients with a confirmed aneurysm admitted between 1999 and 2007. For its validation we similarly studied 255 patients admitted between 2007 and 2009. The predictive value of admission characteristics was tested in logistic regression models with delayed cerebral ischemia-related infarction as primary outcome. Procedure-related infarctions were not included. Performance of the models was tested by discrimination and calibration. On the basis of these models, a risk chart was developed for application in clinical practice.
RESULTS
The strongest predictors were clinical condition on admission, amount of blood on computed tomography (both cisternal and intraventricular) and age. A model that combined these 4 predictors had an area under the receiver operating characteristic curve of 0.63 (95% confidence interval, 0.57-0.69). This model improved little by including current smoking and hyperglycemia on admission (area under the receiver operating characteristic curve, 0.65; 95% confidence interval, 0.59-0.71). The risk chart predicted risks of delayed cerebral ischemia-related infarction varying from 12% to 61%. Both low risk (<20% risk) and high risk (>40% risk) were predicted in ≈20% of the patients. Validation confirmed that the discriminative ability was adequate (area under the receiver operating characteristic curve, 0.69; 95% confidence interval, 0.61-0.77).
CONCLUSIONS
Absolute risks of delayed cerebral ischemia-related infarction can be reliably estimated by a simple risk chart that includes clinical condition on admission, amount of blood on computed tomography (both cisternal and intraventricular), and age.
背景与目的
基于入院特征，开发并验证一种用于预测颅内动脉瘤性蛛网膜下腔出血后迟发性脑缺血的风险图表。
方法
为了推导风险图表，我们研究了 1999 年至 2007 年间连续前瞻性收集的 371 例确诊颅内动脉瘤伴蛛网膜下腔出血患者的数据。为了验证其有效性，我们同样研究了 2007 年至 2009 年间收治的 255 例患者。将与迟发性脑缺血相关的梗死作为主要结局，通过逻辑回归模型测试入院特征的预测价值。不包括与操作相关的梗死。通过区分度和校准来测试模型的性能。基于这些模型，开发了一个风险图表，用于临床实践。
结果
最强的预测因素是入院时的临床状况、计算机断层扫描（脑池和脑室）中的出血量和年龄。结合这 4 个预测因素的模型，其受试者工作特征曲线下面积为 0.63（95%置信区间，0.57-0.69）。通过纳入入院时的当前吸烟和高血糖，该模型的预测值略有提高（受试者工作特征曲线下面积，0.65；95%置信区间，0.59-0.71）。风险图表预测迟发性脑缺血相关梗死的风险从 12%到 61%不等。约 20%的患者被预测为低风险（<20%的风险）和高风险（>40%的风险）。验证确认区分能力是充分的（受试者工作特征曲线下面积，0.69；95%置信区间，0.61-0.77）。
结论
通过包括入院时的临床状况、计算机断层扫描（脑池和脑室）中的出血量和年龄在内的简单风险图表，可以可靠地估计迟发性脑缺血相关梗死的绝对风险。
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