Zijlmans Jendé L, Coert Bert A, van den Berg René, Sprengers Marieke E S, Majoie Charles B L M, Vandertop W Peter, Verbaan Dagmar
Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
Department of Neuroradiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
World Neurosurg. 2018 Oct;118:e217-e222. doi: 10.1016/j.wneu.2018.06.157. Epub 2018 Jun 30.
Patients with an aneurysmal subarachnoid hemorrhage (aSAH) and World Federation of Neurosurgical Societies (WFNS) grade I on admission are generally considered to have a good clinical outcome.
The objective of this study was to assess the actual clinical outcome of WFNS grade I aSAH patients, and to determine which factors are associated with unfavourable outcome.
For this prospective cohort study, 132 consecutive patients (age 18 years or older) with a WFNS grade I aSAH admitted to our hospital between December 2011 and January 2016 were eligible. Clinical outcome was measured using the modified Rankin Scale (mRS) at 6-month follow-up. Unfavorable outcome was defined as an mRS score of 3-6. Univariable analyses were performed using logistic regression models.
Of 116 patients, only 5 patients (4%) had an mRS score of 0 and most (65%) had an mRS score of 2. Twenty-five patients (22%) had an unfavorable outcome. Nine (8%) patients died, of whom 4 died during admission. Factors associated with unfavorable outcome were age (per increasing decade: odds ratio [OR]. 1.78; 95% confidence interval [CI], 1.16-2.72), delayed cerebral ischemia (OR, 4.32; 95% CI, 1.63-11.44), pneumonia (OR, 10.75; 95% CI, 1.94-59.46) and meningitis (OR, 28.47; 95% CI, 1.42-571.15).
Despite their neurologically optimal clinical condition on admission, 1 in 5 patients with WFNS grade I aSAH has an unfavorable clinical outcome or is dead at 6-month follow-up. Additional multivariable analysis in larger patient cohorts is necessary to identify the extent to which preventable complications contribute to unfavorable outcomes in these patients.
入院时为动脉瘤性蛛网膜下腔出血（aSAH）且世界神经外科协会联盟（WFNS）分级为I级的患者通常被认为临床预后良好。
本研究的目的是评估WFNS I级aSAH患者的实际临床预后，并确定哪些因素与不良预后相关。
对于这项前瞻性队列研究，选取2011年12月至2016年1月期间连续入住我院的132例（年龄18岁及以上）WFNS I级aSAH患者作为研究对象。在6个月随访时使用改良Rankin量表（mRS）评估临床预后。不良预后定义为mRS评分为3 - 6分。使用逻辑回归模型进行单变量分析。
116例患者中，仅有5例（4%）mRS评分为0，大多数（65%）mRS评分为2。25例（22%）患者预后不良。9例（8%）患者死亡，其中4例在住院期间死亡。与不良预后相关的因素包括年龄（每增加十岁：比值比[OR] 1.78；95%置信区间[CI]，1.16 - 2.72）、迟发性脑缺血（OR，4.32；95% CI，1.63 - 11.44）、肺炎（OR，10.75；95% CI，1.94 - 59.46）和脑膜炎（OR，28.47；95% CI，1.42 - 571.15）。
尽管入院时神经功能状态最佳，但五分之一的WFNS I级aSAH患者在6个月随访时预后不良或死亡。需要在更大的患者队列中进行额外的多变量分析，以确定可预防并发症在这些患者不良预后中所起作用的程度。
