Pegoli Marianna, Mandrekar Jay, Rabinstein Alejandro A, Lanzino Giuseppe
Departments of Neurosurgery.
J Neurosurg. 2015 Feb;122(2):414-8. doi: 10.3171/2014.10.JNS14290. Epub 2014 Dec 12.
Case fatality rates after aneurysmal subarachnoid hemorrhage (aSAH) have decreased over time, and many patients treated with modern paradigms return to a normal life. However, there is little information on predictors of excellent functional outcome after aSAH. In this study, the authors investigated predictors of excellent outcome in a modern consecutive series of patients with aSAH.
A retrospective review was conducted of patients with aSAH admitted between 2001 and 2013. The primary outcome measure was excellent functional outcome, defined as modified Rankin Scale (mRS) score of 0 or 1 at last follow-up within 1 year of aSAH.
Three hundred seventy-three patients were identified with posthospital follow-up. Excellent outcome was noted in 236 patients (63.3%), including an mRS score of 0 in 122 (32.7%) and an mRS score of 1 in 114 (30.6%). On univariate analysis, the following factors were associated with an excellent outcome: indicators of less severe bleeding, such as better World Federation of Neurosurgical Societies grade at any of the times of assessment, better modified Fisher grade, and absence of intracerebral hemorrhage (ICH), intraventricular hemorrhage (IVH), and symptomatic hydrocephalus; aneurysm treatment with coil embolization; absence of symptomatic vasospasm, delayed cerebral ischemia, and radiological infarction; absence of in-hospital seizures; lack of need for CSF diversion; fewer hours with fever; less severe anemia; and absence of transfusion. On multivariable analysis, the 4 variables that were most strongly associated with excellent outcome were presence of good clinical grade after neurological resuscitation, absence of ICH on initial CT scan, blood transfusion during the hospitalization, and radiological infarctions on final brain imaging.
Excellent outcomes (mRS score 0-1) can be achieved in the majority of patients with aSAH. The likelihood of excellent outcome is predicted by good clinical condition after resuscitation, absence of ICH on presentation, no evidence of infarction on brain imaging, and absence of blood transfusion during hospitalization.
随着时间推移，动脉瘤性蛛网膜下腔出血（aSAH）后的病死率有所下降，许多接受现代治疗模式的患者恢复了正常生活。然而，关于aSAH后功能预后良好的预测因素的信息却很少。在本研究中，作者调查了现代连续系列aSAH患者功能预后良好的预测因素。
对2001年至2013年期间收治的aSAH患者进行回顾性研究。主要结局指标为功能预后良好，定义为在aSAH后1年内最后一次随访时改良Rankin量表（mRS）评分为0或1。
共确定373例患者进行出院后随访。236例患者（63.3%）预后良好，其中mRS评分为0的有122例（32.7%），mRS评分为1的有114例（30.6%）。单因素分析显示，以下因素与良好预后相关：出血较轻的指标，如在任何评估时间点世界神经外科联合会分级较好、改良Fisher分级较好，以及无脑出血（ICH）、脑室内出血（IVH）和症状性脑积水；采用弹簧圈栓塞治疗动脉瘤；无症状性血管痉挛、迟发性脑缺血和放射性梗死；无院内癫痫发作；无需脑脊液分流；发热时间较短；贫血较轻；未输血。多因素分析显示，与良好预后最密切相关的4个变量为神经复苏后临床分级良好、初始CT扫描无ICH、住院期间输血以及最终脑部影像学检查有放射性梗死。
大多数aSAH患者可实现良好预后（mRS评分0 - 1）。复苏后临床状况良好、就诊时无ICH、脑部影像学检查无梗死证据以及住院期间未输血可预测良好预后的可能性。
