From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria.
Institute of Medical Informatics, UMIT: University for Health Sciences, Medical Informatics and Technology, Hall, Austria (B.-A.I., ).
Stroke. 2019 Apr;50(4):828-836. doi: 10.1161/STROKEAHA.118.024283.
Background and Purpose- Global cerebral edema occurs in up to 57% of patients with subarachnoid hemorrhage (SAH) and is associated with prolonged hospital stay and poor outcome. Recently, admission brain edema was successfully graded using a simplified computed tomography-based semiquantitative score (subarachnoid hemorrhage early brain edema score [SEBES]). Longitudinal evaluation of the SEBES grade may discriminate patients with rapid and delayed edema resolution after SAH. Here, we aimed to describe the resolution of brain edema and to study the relationship between this radiographic biomarker and hospital course and outcome after SAH. Methods- For the current observational cohort study, computed tomography scans of 283 consecutive nontraumatic SAH patients admitted to the neurological intensive care unit of a tertiary hospital were graded based on the absence of visible sulci at 2 predefined brain tissue levels in each hemisphere (SEBES ranging from 0 to 4). A score of ≥3 was defined as high-grade SEBES. Multivariable regression models using generalized linear models were used to identify associated factors with delayed edema resolution based on the median time to resolution (SEBES ≤2) in SAH survivors. Results- Patients were 57 years old (interquartile range, 48-68) and presented with a median admission Hunt and Hess grade of 3 (interquartile range, 1-5). High-grade SEBES was common (106/283, 37%) and resolved within a median of 8 days (interquartile range, 4-15) in survivors (N=80). Factors associated with delayed edema resolution were early (<72 hours) hypernatremia (>150 mmol/L; adjusted odds ratio [adjOR], 4.88; 95% CI, 1.68-14.18), leukocytosis (>15 G/L; adjOR, 3.14; 95% CI, 1.24-8.77), hyperchloremia (>121 mmol/L; adjOR, 5.24; 95% CI, 1.64-16.76), and female sex (adjOR, 3.71; 95% CI, 1.01-13.64) after adjusting for admission Hunt and Hess grade and age. Delayed brain edema resolution was an independent predictor of worse functional 3-month outcome (adjOR, 2.52; 95% CI, 1.07-5.92). Conclusions- Our data suggest that repeated quantification of the SEBES can identify SAH patients with delayed edema resolution. Based on its' prognostic value as radiographic biomarker, the SEBES may be integrated in future trials aiming to improve edema resolution after SAH.
背景与目的-全球脑水肿发生于多达 57%的蛛网膜下腔出血（SAH）患者中，与住院时间延长和预后不良相关。最近，使用简化的基于计算机断层扫描的半定量评分（蛛网膜下腔出血早期脑水肿评分 [SEBES]）成功分级了入院时的脑水肿。SEBES 分级的纵向评估可能可以区分 SAH 后快速和延迟性脑水肿消退的患者。在此，我们旨在描述脑水肿的消退情况，并研究该影像学生物标志物与 SAH 后的住院过程和结局之间的关系。方法-对于当前的观察性队列研究，对 283 例连续非创伤性 SAH 患者的计算机断层扫描进行分级，基于在每个半球的 2 个预设脑组织水平上是否可见脑沟（SEBES 范围为 0 至 4）。定义 SEBES 评分≥3 为高级别 SEBES。使用广义线性模型的多变量回归模型，基于 SAH 幸存者中（SEBES≤2）的中位缓解时间（定义为缓解），确定与延迟性脑水肿缓解相关的因素。结果-患者年龄为 57 岁（四分位距，48-68），入院时中位 Hunt 和 Hess 分级为 3 级（四分位距，1-5）。高级别 SEBES 很常见（283 例患者中有 106 例，占 37%），幸存者中在中位 8 天（四分位距，4-15）内缓解（N=80）。与延迟性脑水肿缓解相关的因素包括早期（<72 小时）高钠血症（>150 mmol/L；调整后的优势比[adjOR]，4.88；95%CI，1.68-14.18）、白细胞增多症（>15 G/L；adjOR，3.14；95%CI，1.24-8.77）、高氯血症（>121 mmol/L；adjOR，5.24；95%CI，1.64-16.76）和女性（adjOR，3.71；95%CI，1.01-13.64），校正入院时的 Hunt 和 Hess 分级和年龄后。延迟性脑水肿缓解是 3 个月功能结局较差的独立预测因素（adjOR，2.52；95%CI，1.07-5.92）。结论-我们的数据表明，反复定量 SEBES 可以识别出脑水肿延迟缓解的 SAH 患者。基于其作为影像学生物标志物的预后价值，SEBES 可能会被纳入旨在改善 SAH 后水肿缓解的未来试验中。
