Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Department of Neurosurgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
CNS Neurosci Ther. 2019 Oct;25(10):1173-1181. doi: 10.1111/cns.13202. Epub 2019 Aug 12.
The aim of this study is to identify the early predictors for delayed cerebral ischemia (DCI) and develop a risk stratification score by focusing on the early change after aneurysmal subarachnoid hemorrhage (aSAH).
The study retrospectively reviewed aSAH patients between 2014 and 2015. Risk factors within 72 hours after aSAH were included into univariable and multivariable logistic regression analysis to screen the independent predictors for DCI and to design a risk stratification score.
We analyzed 702 aSAH patients; four predictors were retained from the final multivariable analysis: World Federation of Neurosurgical Societies scale (WFNS; OR = 4.057, P < .001), modified Fisher Scale (mFS; OR = 2.623, P < .001), Subarachnoid Hemorrhage Early Brain Edema Score (SEBES; OR = 1.539, P = .036), and intraventricular hemorrhage (IVH; OR = 1.932, P = .002). According to the regression coefficient, we created a risk stratification score ranging from 0 to 7 (WFNS = 3, mFS = 2, SEBES = 1, and IVH = 1). The new score showed a significantly higher area under curve (0.785) compared with other scores (P < .001).
The early DCI score provides a practical method at the early 72 hours after aSAH to predict DCI.
本研究旨在确定迟发性脑缺血（DCI）的早期预测因素，并通过关注颅内动脉瘤性蛛网膜下腔出血（aSAH）后的早期变化，制定一种风险分层评分。
本研究回顾性分析了 2014 年至 2015 年间的 aSAH 患者。将 aSAH 后 72 小时内的危险因素纳入单变量和多变量逻辑回归分析，以筛选出 DCI 的独立预测因素，并设计风险分层评分。
我们分析了 702 例 aSAH 患者，最终多变量分析保留了 4 个预测因素：世界神经外科学会联合会分级（WFNS；OR=4.057，P<.001）、改良 Fisher 分级（mFS；OR=2.623，P<.001）、蛛网膜下腔出血早期脑水肿评分（SEBES；OR=1.539，P=.036）和脑室内出血（IVH；OR=1.932，P=.002）。根据回归系数，我们创建了一个风险分层评分，范围从 0 到 7（WFNS=3，mFS=2，SEBES=1，IVH=1）。新评分的曲线下面积（AUC）显著高于其他评分（P<.001）。
早期 DCI 评分在 aSAH 后 72 小时内提供了一种预测 DCI 的实用方法。
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