Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Neurology and Neurosurgery Department, Universidade Federal de São Paulo, São Paulo, Brazil; Department of Critical Care Medicine, Trauma and Neurosurgical Intensive Care Unit, University of Toronto, Toronto, Ontario, Canada; Division of Interventional Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Neuroscience Research Program, Keenan Research Centre, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada.
World Neurosurg. 2019 Nov;131:e508-e513. doi: 10.1016/j.wneu.2019.07.221. Epub 2019 Aug 6.
Poor-grade subarachnoid hemorrhage (SAH) has been associated with a high case fatality, either in the acute phase or in the later stages. The exact causes of death in these patients are unknown.
We performed a retrospective study of all consecutive patients with SAH with World Federation of Neurosurgical Societies grade IV or V on admission from 2009 to 2013 at 2 tertiary referral centers in Amsterdam, the Netherlands, and Toronto, Ontario, Canada, who had died during their hospital stay.
Of 357 patients, 152 (43%) had died. Of these 152 patients, 87 (24%) had not undergone aneurysm treatment. The median interval to death was 3 days (interquartile range, 1-12 days) after initial hemorrhage. The major cause of death in both centers was withdrawal of life support (107 patients [71%]; 74 of 94 [79%] in Amsterdam and 33 of 58 [58%] in Toronto; P < 0.01), followed by brain death in 23 (15%; 16 of 58 [28%] in Amsterdam vs. 7 of 94 [7%] in Toronto; P < 0.01). The remaining causes of death represented <15%.
The decision to withdraw life support was the major reason for death of patients with poor-grade SAH for an overwhelming majority of the patients. The exact reasons for withdrawal of life support, other than cultural and referral differences, were undetermined. Insight into the reasons of death should be prospectively studied to improve the care and clinical outcomes of patients with poor-grade SAH.
无论是在急性期还是在晚期，较差级别的蛛网膜下腔出血（SAH）与高病死率相关。这些患者的具体死亡原因尚不清楚。
我们对 2009 年至 2013 年期间在荷兰阿姆斯特丹和加拿大安大略省多伦多的 2 个三级转诊中心连续收治的 WFNS 分级 IV 或 V 的所有 SAH 患者进行了回顾性研究，这些患者在住院期间死亡。
在 357 例患者中，有 152 例（43%）死亡。在这 152 例患者中，有 87 例（24%）未接受动脉瘤治疗。从最初出血到死亡的中位时间为 3 天（四分位间距 1-12 天）。两个中心死亡的主要原因均为撤除生命支持（107 例[71%]；阿姆斯特丹 94 例中有 74 例[79%]，多伦多 58 例中有 33 例[58%]；P<0.01），其次是脑死亡（23 例[15%]；阿姆斯特丹 58 例中有 16 例[28%]，多伦多 94 例中有 7 例[7%]；P<0.01）。其余死因<15%。
对于绝大多数较差级别的 SAH 患者，撤除生命支持是导致死亡的主要原因。除了文化和转诊差异外，撤除生命支持的具体原因尚未确定。前瞻性研究死亡原因应有助于改善较差级别的 SAH 患者的护理和临床结局。
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