颅内动脉瘤性蛛网膜下腔出血后分流的风险：一项协作研究和联盟的发起。
Risk of Shunting After Aneurysmal Subarachnoid Hemorrhage: A Collaborative Study and Initiation of a Consortium.
机构信息
From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Finland (H.A., V.L., J. Huttunen, T.S., A.L., J.F., M.F., T.K., J.E.J., T.J.H.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (V.S.B., S.G.A., B.G.W.); and Department of Neurosurgery, Helsinki University Hospital, Finland (J. Hernesniemi).
出版信息
Stroke. 2016 Oct;47(10):2488-96. doi: 10.1161/STROKEAHA.116.013739. Epub 2016 Sep 15.
BACKGROUND AND PURPOSE
Shunt dependent hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) is a common sequela that may lead to poor neurological outcome and predisposes to various interventions, admissions, and complications. We reviewed post-aSAH shunt dependency in a population-based sample and tested the feasibility of a clinical risk score to identify subgroups of aSAH patients with increasing risk of shunting for hydrocephalus.
METHODS
A total of 1533 aSAH patients from the population-based Eastern Finland Saccular Intracranial Aneurysm Database (Kuopio, Finland) were used in a recursive partitioning analysis to identify risk factors for shunting after aSAH. The risk model was built and internally validated in random split cohorts. External validation was conducted on 946 aSAH patients from the Southwestern Tertiary Aneurysm Registry (Dallas, TX) and tested using receiver-operating characteristic curves.
RESULTS
Of all patients alive ≥14 days, 17.7% required permanent cerebrospinal fluid diversion. The recursive partitioning analysis defined 6 groups with successively increased risk for shunting. These groups also successively risk stratified functional outcome at 12 months, shunt complications, and time-to-shunt rates. The area under the curve-receiver-operating characteristic curve for the exploratory sample and internal validation sample was 0.82 and 0.78, respectively, with an external validation of 0.68.
CONCLUSIONS
Shunt dependency after aSAH is associated with higher morbidity and mortality, and prediction modeling of shunt dependency is feasible with clinically useful yields. It is important to identify and understand the factors that increase risk for shunting and to eliminate or mitigate the reversible factors. The aSAH-PARAS Consortium (Aneurysmal Subarachnoid Hemorrhage Patients' Risk Assessment for Shunting) has been initiated to pool the collective insights and resources to address key questions in post-aSAH shunt dependency to inform future aSAH treatment guidelines.
背景与目的
蛛网膜下腔出血（aSAH）后出现分流依赖性脑积水是一种常见的后遗症，可能导致不良的神经预后，并易导致各种干预、住院和并发症。我们在基于人群的样本中回顾了 aSAH 后分流依赖性，并测试了临床风险评分的可行性，以确定具有增加分流风险的 aSAH 患者亚组。
方法
使用基于人群的芬兰东部囊状颅内动脉瘤数据库（Kuopio，芬兰）中的 1533 例 aSAH 患者进行递归分区分析，以确定 aSAH 后分流的危险因素。在随机分割队列中构建和内部验证风险模型。在来自德克萨斯州达拉斯市西南三级动脉瘤登记处（Southwestern Tertiary Aneurysm Registry）的 946 例 aSAH 患者中进行外部验证，并使用接受者操作特征曲线进行测试。
结果
所有存活≥14 天的患者中，有 17.7%需要永久性脑脊液分流。递归分区分析定义了 6 个分组，分组的分流风险逐渐增加。这些分组还依次对 12 个月时的功能结局、分流并发症和分流时间进行风险分层。探索性样本和内部验证样本的曲线下面积-接受者操作特征曲线分别为 0.82 和 0.78，外部验证为 0.68。
结论
aSAH 后分流依赖性与更高的发病率和死亡率相关，并且可以通过具有临床有用效果的预测模型来预测分流依赖性。识别和理解增加分流风险的因素并消除或减轻可逆转的因素非常重要。已经启动了 aSAH-PARAS 联盟（Aneurysmal Subarachnoid Hemorrhage Patients' Risk Assessment for Shunting），以汇集集体见解和资源，解决 aSAH 后分流依赖性方面的关键问题，为未来的 aSAH 治疗指南提供信息。
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