Abulhasan Yasser B, Alabdulraheem Najayeb, Simoneau Gabrielle, Angle Mark R, Teitelbaum Jeanne
Neurological Intensive Care Unit, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Faculty of Medicine, Health Sciences Center, Kuwait University, Kuwait.
Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.
World Neurosurg. 2018 Apr;112:e799-e811. doi: 10.1016/j.wneu.2018.01.160. Epub 2018 Feb 2.
To evaluate primary causes of death after spontaneous subarachnoid hemorrhage (SAH) and externally validate the HAIR score, a prognostication tool, in a single academic institution.
We reviewed all patients with SAH admitted to our neuro-intensive care unit between 2010 and 2016. Univariate and multivariate logistic regressions were performed to identify predictors of in-hospital mortality. The HAIR score predictors were Hunt and Hess grade at treatment decision, age, intraventricular hemorrhage, and rebleeding within 24 hours. Validation of the HAIR score was characterized with the receiver operating curve, the area under the curve, and a calibration plot.
Among 434 patients with SAH, in-hospital mortality was 14.1%. Of the 61 mortalities, 54 (88.5%) had a neurologic cause of death or withdrawal of care and 7 (11.5%) had cardiac death. Median time from SAH to death was 6 days. The main causes of death were effect of the initial hemorrhage (26.2%), rebleeding (23%) and refractory cerebral edema (19.7%). Factors significantly associated with in-hospital mortality in the multivariate analysis were age, Hunt and Hess grade, and intracerebral hemorrhage. Maximum lumen size was also a significant risk factor after aneurysmal SAH. The HAIR score had a satisfactory discriminative ability, with an area under the curve of 0.89.
The in-hospital mortality is lower than in previous reports, attesting to the continuing improvement of our institutional SAH care. The major causes are the same as in previous reports. Despite a different therapeutic protocol, the HAIR score showed good discrimination and could be a useful tool for predicting mortality.
评估自发性蛛网膜下腔出血（SAH）后的主要死亡原因，并在单一学术机构对外验证一种预后工具HAIR评分。
我们回顾了2010年至2016年间入住我院神经重症监护病房的所有SAH患者。进行单因素和多因素逻辑回归分析以确定院内死亡的预测因素。HAIR评分的预测因素为治疗决策时的Hunt和Hess分级、年龄、脑室内出血以及24小时内再出血。通过受试者工作曲线、曲线下面积和校准图对HAIR评分进行验证。
434例SAH患者中，院内死亡率为14.1%。在61例死亡病例中，54例（88.5%）死于神经系统原因或放弃治疗，7例（11.5%）死于心脏原因。SAH至死亡的中位时间为6天。主要死亡原因是初始出血的影响（26.2%）、再出血（23%）和难治性脑水肿（19.7%）。多因素分析中与院内死亡显著相关的因素为年龄、Hunt和Hess分级以及脑出血。最大管腔尺寸也是动脉瘤性SAH后的一个显著危险因素。HAIR评分具有良好的鉴别能力，曲线下面积为0.89。
我院的院内死亡率低于既往报道，证明我们机构对SAH的治疗在持续改进。主要死亡原因与既往报道相同。尽管治疗方案不同，但HAIR评分显示出良好的鉴别能力，可能是预测死亡率的有用工具。
