Galea James P, Dulhanty Louise, Patel Hiren C
From the Vascular and Stroke Center, Institute of Cardiovascular Sciences, Manchester Academic Health Sciences Center, University of Manchester, United Kingdom (J.P.G., H.C.P.); Greater Manchester Neurosciences Center, Salford Royal Foundation NHS Trust, United Kingdom (L.D., H.C.P.); and Ninewells Hospital and Medical School, Ninewells, Dundee, United Kingdom (J.P.G.).
Stroke. 2017 Nov;48(11):2958-2963. doi: 10.1161/STROKEAHA.117.017777. Epub 2017 Oct 3.
The mortality and morbidity after aneurysmal subarachnoid hemorrhage has improved because of better diagnosis, early treatment to secure the aneurysm, and better management of disease-specific complications. With these improvements in care, it is not clear if the previously identified independent predictors of a negative outcome have changed. The aim of this study was to identify the independent predictors of an unfavorable outcome (Glasgow Outcome Score 1, 2, and 3) in aneurysmal subarachnoid hemorrhage patients.
Univariate and multivariate analysis of prospectively collected data on patients presenting with an aneurysmal subarachnoid hemorrhage was performed. Outcome was assessed at discharge. Data were collected from 14 centers in the United Kingdom over a period of 4 years (September 2011-2015).
The median age (interquartile range) at presentation of 3341 patients with aneurysmal subarachnoid hemorrhage was 55 (18) years. Most patients were female (n=2288 [68.5%]), presented in good grade (2397 [70%]; World Federation of Neurological Surgeons grade 1 and 2), and were treated by endovascular coiling (n=2600; 75%). The independent predictors of an unfavorable outcome (95% confidence interval [CI]) were increasing age (odds ratio [OR], 1.04; 95% CI, 1.03-1.05; <0.001), World Federation of Neurological Surgeons grade (OR, 2.06; 95% CI, 1.91-2.22; <0.001), preoperative rebleeding (OR, 7.41; 95% CI, 4.48-12.30; <0.001), need for cerebrospinal fluid diversion (OR, 3.25; 95% CI, 2.58-4.09; <0.001), and delayed cerebral ischemia (OR, 2.21; 95% CI, 1.72-2.83; <0.001).
These data suggest that potentially modifiable risk factors of preoperative rebleeding and delayed cerebral ischemia are associated with unfavorable outcomes. Understanding the reasons why patients requiring cerebrospinal fluid diversion have 3.25-fold higher adjusted odds of a poor outcome at discharge needs to be studied.
由于诊断水平提高、早期治疗以确保动脉瘤安全以及对特定疾病并发症的更好管理，动脉瘤性蛛网膜下腔出血后的死亡率和发病率有所改善。随着这些护理方面的改善，之前确定的不良预后独立预测因素是否发生变化尚不清楚。本研究的目的是确定动脉瘤性蛛网膜下腔出血患者不良预后（格拉斯哥预后评分1、2和3）的独立预测因素。
对前瞻性收集的动脉瘤性蛛网膜下腔出血患者数据进行单因素和多因素分析。出院时评估预后。在4年期间（2011年9月至2015年）从英国的14个中心收集数据。
3341例动脉瘤性蛛网膜下腔出血患者就诊时的中位年龄（四分位间距）为55（18）岁。大多数患者为女性（n = 2288 [68.5%]），分级良好（2397 [70%]；世界神经外科联合会分级1和2），并接受血管内栓塞治疗（n = 2600；75%）。不良预后的独立预测因素（95%置信区间[CI]）为年龄增加（比值比[OR]，1.04；95%CI，1.03 - 1.05；<0.001）、世界神经外科联合会分级（OR，2.06；95%CI，1.91 - 2.22；<0.001）、术前再出血（OR，7.41；95%CI，4.48 - 12.30；<0.001）、脑脊液引流需求（OR，3.25；95%CI，2.58 - 4.09；<0.001）和迟发性脑缺血（OR，2.21；95%CI，1.72 - 2.83；<0.001）。
这些数据表明，术前再出血和迟发性脑缺血等潜在可改变的危险因素与不良预后相关。需要研究为什么需要脑脊液引流的患者出院时调整后的不良预后几率高出3.25倍。
