Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea.
Neurosurgery. 2013 Sep;73(3):450-7; quiz 457. doi: 10.1227/NEU.0000000000000001.
Cardiac dysfunction is a well-known complication of aneurysmal subarachnoid hemorrhage (aSAH). However, the clinical significance of cardiac complications is largely unknown.
To determine whether cardiac complications are independently related to outcomes and to identify potential predictors associated with these complications.
We extracted all hospitalizations for aSAH from the National Inpatient Sample database for years 2002 to 2009. We used generalized estimating equations to determine whether cardiac complications were associated with the patient outcomes and to evaluate potential predictors of cardiac complications.
Among 53713 cases of aSAH, there were 3609 (6.72%) and 151 (0.28%) incidences of cardiac failure (CF) and myocardial infarction (MI), respectively. The overall in-hospital mortality rate was 24.8%, whereas the mortality rate for patients with CF was 34.4% and the mortality rate for patients with MI was 29.8%. Patients who experienced CF were significantly more likely than other patients to die in the hospital (odds ratio: 1.6, 95% confidence interval: 1.47-1.68; P < .001). The difference in mortality rates between MI patients and other patients, however, was not statistically significant. The generalized estimating equation model identified 7 factors that were predictive of CF: age, sex, race, primary payer, diabetes, smoker, and cardiac disease. For MI, the model identified age, race, and primary payer as significant predictors of MI.
Our results suggest that an important association exists between cardiac complications and mortality/morbidity in aSAH patients. aSAH patients with CF appear to have a higher mortality rate, longer hospital length of stay, and higher hospitalization costs compared with those without CF.
心脏功能障碍是蛛网膜下腔出血（aSAH）的已知并发症。然而，心脏并发症的临床意义在很大程度上尚未可知。
确定心脏并发症是否与结局独立相关，并确定与这些并发症相关的潜在预测因素。
我们从 2002 年至 2009 年的国家住院患者样本数据库中提取了所有 aSAH 住院患者。我们使用广义估计方程来确定心脏并发症是否与患者结局相关，并评估心脏并发症的潜在预测因素。
在 53713 例 aSAH 中，分别有 3609（6.72%）和 151（0.28%）例发生心力衰竭（CF）和心肌梗死（MI）。总的住院死亡率为 24.8%，而 CF 患者的死亡率为 34.4%，MI 患者的死亡率为 29.8%。发生 CF 的患者在医院死亡的可能性明显高于其他患者（比值比：1.6，95%置信区间：1.47-1.68；P <.001）。然而，MI 患者与其他患者的死亡率差异无统计学意义。广义估计方程模型确定了 7 个可预测 CF 的因素：年龄、性别、种族、主要支付者、糖尿病、吸烟者和心脏病。对于 MI，该模型确定了年龄、种族和主要支付者是 MI 的显著预测因素。
我们的结果表明，心脏并发症与 aSAH 患者的死亡率/发病率之间存在重要关联。与无 CF 的患者相比，CF 的 aSAH 患者似乎具有更高的死亡率、更长的住院时间和更高的住院费用。
