Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Mölndal, Sweden.
Institution of clinical sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Acta Neurol Scand. 2018 Nov;138(5):400-407. doi: 10.1111/ane.12980. Epub 2018 Jul 2.
Patients with aneurysmal subarachnoid hemorrhage (aSAH) have poor outcome. Studies on outcome beyond 1 year post-aSAH are few, and late recovery is poorly investigated, initiating this prospective outcome study on patients 12-15 years after an aSAH. We hypothesized to find; functional improvement > 1 year post-ictus; increased long-term mortality in aSAH patients vs matched controls, and finally to present; predictors of long-term favorable outcome (GOS 4-5).
We prospectively investigated patients, admitted 2000-2003 to the Sahlgrenska University Hospital, 1 year post-ictus using Glasgow Outcome Scale (GOS). The patients were revalidated 12-15 years post-aSAH by structured-telephone interviews (GOS), followed by statistical analysis.
A total of 158 patients were included, (women n = 114, men n = 44), with a mean age of 55 years at aSAH. Patients treated with surgical clipping had lower mortality. At the follow-up 12-15 years post-aSAH, all 103 survivors (65.2%) were categorized as having; good recovery (39.9%), moderate disability (15.2%), or severe disability (10.1%). Within the patient cohort, 23.6% improved GOS over time. Fifty-five patients died, median at 4 years post-ictus. aSAH patients had 3.5 times increased mortality 12-15 years post-ictus vs matched controls (P < .0001). Patients with favorable outcome at 1 year (67.3%, n = 101) had similar survival probability as control patients. Prognostic indicators of long-term favorable outcome were low age and high GOS at 1-year follow-up, (AUCROC, 0.79).
Individual functional improvement was found >1 year post-ictus. Patients with favorable outcome at 1 year had similar long-term life expectancy as the general population. Indicators of long-term favorable prognosis were low age at ictus and high GOS at 1-year follow-up.
患有颅内动脉瘤性蛛网膜下腔出血（aSAH）的患者预后较差。关于 aSAH 后 1 年以上的预后研究较少，对晚期恢复的研究也很少，因此本研究前瞻性地对 aSAH 后 12-15 年的患者进行了预后研究。我们假设会发现：发病后 1 年以上出现功能改善；与匹配的对照组相比，aSAH 患者的长期死亡率增加；最后，我们提出了长期预后良好的预测因素（GOS 4-5）。
我们前瞻性地调查了 2000-2003 年在萨赫勒格伦斯卡大学医院发病后 1 年的患者，使用格拉斯哥预后量表（GOS）进行评估。然后通过结构化电话访谈（GOS）对患者进行重新验证，随访时间为 aSAH 后 12-15 年，最后进行统计学分析。
共纳入 158 例患者（女性 n=114，男性 n=44），发病时平均年龄为 55 岁。接受手术夹闭治疗的患者死亡率较低。在 aSAH 后 12-15 年的随访中，所有 103 例幸存者（65.2%）的分类结果为：良好恢复（39.9%）、中度残疾（15.2%）或重度残疾（10.1%）。在患者队列中，23.6%的患者在随访期间 GOS 有所改善。55 例患者死亡，中位时间为发病后 4 年。aSAH 患者在发病后 12-15 年的死亡率比匹配的对照组高 3.5 倍（P<.0001）。在发病后 1 年预后良好的患者（67.3%，n=101）与对照组患者的生存概率相似。长期预后良好的预测指标为发病时年龄较低和 1 年时 GOS 较高（AUCROC，0.79）。
我们发现发病后 1 年以上出现了个体功能改善。在发病后 1 年预后良好的患者与普通人群具有相似的长期预期寿命。长期预后良好的指标为发病时年龄较小和 1 年时 GOS 较高。
