Darkwah Oppong Marvin, Gümüs Meltem, Pierscianek Daniela, Herten Annika, Kneist Andreas, Wrede Karsten, Barthel Lennart, Forsting Michael, Sure Ulrich, Jabbarli Ramazan
1Department of Neurosurgery and.
2Institute for Diagnostic and Interventional Radiology, University Hospital, University of Duisburg-Essen, Essen, Germany.
J Neurosurg. 2018 Nov 30;131(5):1473-1480. doi: 10.3171/2018.7.JNS181119. Print 2019 Nov 1.
Current guidelines for subarachnoid hemorrhage (SAH) include early aneurysm treatment within 72 hours after ictus. However, aneurysm rebleeding remains a crucial complication of SAH. The aim of this study was to identify independent predictors allowing early stratification of SAH patients for rebleeding risk.
All patients admitted to the authors' institution with ruptured aneurysms during a 14-year period were eligible for this retrospective study. Demographic and radiographic parameters, aneurysm characteristics, medical history, and medications as well as baseline parameters at admission (blood pressure and laboratory parameters) were evaluated in univariate and multivariate analyses. A novel risk score was created using independent risk factors.
Data from 984 cases could be included into the final analysis. Aneurysm rebleeding occurred in 58 cases (5.9%), and in 48 of these cases (82.8%) rerupture occurred within 24 hours after SAH. Of over 30 tested associations, preexisting arterial hypertension (p = 0.02; adjusted odds ratio [aOR] 2.56, 1 score point), aneurysm location at the basilar artery (p = 0.001, aOR 4.5, 2 score points), sac size ≥ 9 mm (p = 0.04, aOR 1.9, 1 score point), presence of intracerebral hemorrhage (p = 0.001, aOR 4.29, 2 score points), and acute hydrocephalus (p < 0.001, aOR 6.27, 3 score points) independently predicted aneurysm rebleeding. A score built upon these parameters (0-9 points) showed a good diagnostic accuracy (p < 0.001, area under the curve 0.780) for rebleeding prediction.
Certain patient-, aneurysm-, and SAH-specific parameters can reliably predict aneurysm rerupture. A score developed according to these parameters might help to identify individuals that would profit from immediate aneurysm occlusion.
目前蛛网膜下腔出血（SAH）的指南包括在发病后72小时内尽早进行动脉瘤治疗。然而，动脉瘤再出血仍然是SAH的一个关键并发症。本研究的目的是确定能够对SAH患者再出血风险进行早期分层的独立预测因素。
在14年期间入住作者所在机构的所有破裂动脉瘤患者均符合本回顾性研究的条件。在单因素和多因素分析中评估了人口统计学和影像学参数、动脉瘤特征、病史、用药情况以及入院时的基线参数（血压和实验室参数）。使用独立危险因素创建了一个新的风险评分。
984例病例的数据可纳入最终分析。58例（5.9%）发生动脉瘤再出血，其中48例（82.8%）在SAH后24小时内再次破裂。在超过30种测试的关联中，既往动脉高血压（p = 0.02；调整优势比[aOR] 2.56，1分）、基底动脉处的动脉瘤位置（p = 0.001，aOR 4.5，2分）、瘤囊大小≥9 mm（p = 0.04，aOR 1.9，1分）、脑内出血的存在（p = 0.001，aOR 4.29，2分）和急性脑积水（p < 0.001，aOR 6.27，3分）独立预测动脉瘤再出血。基于这些参数构建的评分（0 - 9分）对再出血预测显示出良好的诊断准确性（p < 0.001，曲线下面积0.780）。
某些患者、动脉瘤和SAH特异性参数能够可靠地预测动脉瘤再次破裂。根据这些参数制定的评分可能有助于识别那些将从立即闭塞动脉瘤中获益的个体。
