Department of Neurology, University of Texas Health Science Center, Houston, Texas.
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Neurosurgery. 2018 Jul 1;83(1):137-145. doi: 10.1093/neuros/nyx364.
Early brain injury (EBI) after subarachnoid hemorrhage (SAH) is an important determinant of clinical outcomes. However, a major hindrance to studies of EBI is the lack of radiographic surrogate marker.
To propose a scoring system based on early changes in clinically obtained computed tomography (CT), called the Subarachnoid hemorrhage Early Brain Edema Score (SEBES).
Patients with spontaneous aneurysmal SAH and a CT within 24 h of ictus were included. We defined SEBES as a scale of 0 to 4 points according to the (1) absence of visible sulci caused by effacement of sulci or (2) absence of visible sulci with disruption of the gray-white matter junction at 2 predetermined levels in each hemisphere. Prognostic value of the SEBES grade for the prediction of delayed cerebral ischemia (DCI) and unfavorable outcomes was assessed. A separate cohort of patients was used as a validation cohort.
Of the 164 subjects in our study, high-grade SEBES (3 or 4 points) was identified in 48 patients (29.3%). CT interobserver reliability of SEBES grades was high with a Kappa value of 0.89. After adjusting for covariables, SEBES was identified as an independent predictor of DCI (OR = 2.24, 95% CI: 1.58-3.17) and unfavorable outcome (OR = 3.45, 95% CI: 1.95-6.07). In our validation cohort, 84 subjects showed similar predictive power of SEBES for a prediction of DCI and unfavorable long-term outcome.
SEBES may be a surrogate marker of EBI and predicts DCI and clinical outcomes after SAH.
蛛网膜下腔出血（SAH）后早期脑损伤（EBI）是临床结局的重要决定因素。然而，EBI 研究的主要障碍是缺乏影像学替代标志物。
提出一种基于发病后 24 小时内临床获得的计算机断层扫描（CT）早期变化的评分系统，称为蛛网膜下腔出血早期脑水肿评分（SEBES）。
纳入自发性蛛网膜下腔出血且发病后 24 小时内行 CT 检查的患者。我们根据以下标准定义 SEBES 为 0 至 4 分：（1）脑沟因脑沟消失而无法辨认，或（2）脑沟消失，灰白质交界中断，在每个半球的 2 个预定水平。评估 SEBES 分级对迟发性脑缺血（DCI）和不良结局的预测价值。另一组患者作为验证队列。
在我们的研究中，164 例患者中，48 例（29.3%）存在高等级 SEBES（3 或 4 分）。SEBES 分级的 CT 观察者间可靠性较高，Kappa 值为 0.89。调整协变量后，SEBES 被确定为 DCI 的独立预测因子（OR=2.24，95%CI：1.58-3.17）和不良结局（OR=3.45，95%CI：1.95-6.07）。在我们的验证队列中，84 例患者中 SEBES 对 DCI 和不良长期结局的预测具有相似的预测能力。
SEBES 可能是 EBI 的替代标志物，可预测 SAH 后 DCI 和临床结局。
