Nassiri Farshad, Ibrahim George M, Badhiwala Jetan H, Witiw Christopher D, Mansouri Alireza, Alotaibi Naif M, Macdonald R Loch
Division of Neurosurgery, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
Labatt Family Centre of Excellence in Brain Injury and Trauma Research, St. Michael's Hospital, Toronto, Canada.
Neurocrit Care. 2016 Dec;25(3):351-358. doi: 10.1007/s12028-016-0266-6.
Inflammation may contribute to poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). Here, we compared outcomes among propensity score-matched cohorts who did and did not receive non-steroidal anti-inflammatory drug (NSAID) use after aSAH.
Propensity score-matched analysis of 413 subjects enrolled in the Clazosentan to Overcome Neurological iSChemia and Infarction OccUring after Subarachnoid hemorrhage (CONSCIOUS-1) study. Propensity score matching was performed on the basis of age, sex, baseline National Institutes of Health Stroke Scale score, World Federation of Neurological Societies grade on admission, procedure used for securing aneurysm, and SAH clot burden.
178 patients were matched (89 received NSAIDs, 89 did not). Propensity score matching was considered acceptable. Patients who had received NSAIDs during their hospital stay had significantly lower mortality rate, and reduced duration of intensive care unit stay and total length of hospital stay (P = 0.035, P = 0.009, and P = 0.053, respectively). At 6 weeks, 80.9 % of patients treated with NSAIDs had good functional outcome compared to 68.5 % of matched controls (P = 0.083). There was no significant difference in the proportions of patients who developed delayed ischemic neurological deficits, angiographic vasospasm, or required rescue therapy.
Inflammation may play a crucial role in the poor outcomes after SAH, and that NSAIDs may be a useful therapeutic option, once validated by larger prospective studies.
炎症可能导致动脉瘤性蛛网膜下腔出血（aSAH）后预后不良。在此，我们比较了aSAH后接受和未接受非甾体抗炎药（NSAID）治疗的倾向评分匹配队列的预后。
对蛛网膜下腔出血后使用克拉生坦克服神经缺血和梗死（CONSCIOUS-1）研究中纳入的413名受试者进行倾向评分匹配分析。倾向评分匹配基于年龄、性别、基线美国国立卫生研究院卒中量表评分、入院时世界神经外科联合会分级、固定动脉瘤所采用的手术以及SAH血凝块负荷进行。
178例患者匹配成功（89例接受NSAIDs治疗，89例未接受）。倾向评分匹配被认为是可接受的。住院期间接受NSAIDs治疗的患者死亡率显著降低，重症监护病房住院时间和总住院时间缩短（分别为P = 0.035、P = 0.009和P = 0.053）。在6周时，接受NSAIDs治疗的患者中有80.9%功能预后良好，而匹配对照组为68.5%（P = 0.083）。发生延迟性缺血性神经功能缺损、血管造影血管痉挛或需要抢救治疗的患者比例无显著差异。
炎症可能在SAH后不良预后中起关键作用，并且NSAIDs可能是一种有用的治疗选择，有待更大规模的前瞻性研究验证。
