Eibach Michael, Won Sae-Yeon, Bruder Markus, Keil Fee, Herrmann Eva, Berkefeld Joachim, Seifert Volker, Konczalla Juergen
1Department of Neurosurgery, University Hospital Frankfurt, Goethe-University.
2Institute of Neuroradiology, University Hospital Frankfurt, Goethe-University; and.
J Neurosurg. 2020 Mar 20;134(3):946-952. doi: 10.3171/2019.12.JNS192744. Print 2021 Mar 1.
The Subarachnoid Hemorrhage Early Brain Edema Score (SEBES) system measures cerebral edema on CT and can be used to predict outcome after subarachnoid hemorrhage (SAH). The authors developed a modified SEBES (SEBES 6c) and assessed whether it could predict outcome after SAH better than the SEBES. Furthermore, they verified the age dependency of these scores.
In this retrospective study, all patients with aneurysmal SAH in the period from January 2011 to February 2017 at a single institution were analyzed. The SEBES, which is based on the absence of visible sulci at two defined CT levels (0-4 points), and the SEBES 6c were determined from the initial CT. The SEBES 6c system includes the two levels from the original SEBES and one level located 2 cm below the vertex (0-6 points). The authors investigated whether the various SEBESs are age dependent and if they can predict delayed infarction (DI) and outcome.
Two hundred sixty-one patients met the study inclusion criteria. The SEBES was an independent predictor for DI (OR 1.6 per 1-point increase) and unfavorable outcome (OR 1.36 per 1-point increase), in accordance with findings in the first publication on SEBES. However, here the authors found that the SEBES was age dependent. In the age group younger than 60 years, the patients with high-grade SEBESs (3-4 points) had DIs and unfavorable outcomes significantly more often than the patients with low-grade scores (0-2 points). In the age groups 60-69 years and ≥ 70 years, no significant differences in DI and outcome were identified between high-grade and low-grade scores, although trends toward DI and unfavorable outcomes among the 60-69 age group were noted in patients with high-grade SEBESs.Receiver operating characteristic curve analysis showed that SEBES 6c had a higher prognostic value in predicting outcome than SEBES (p < 0.001). Furthermore, SEBES 6c predicted an unfavorable outcome (OR 1.31 per 1-point increase) and DI (OR 1.36 per 1-point increase) independent of vasospasms. SEBES 6c showed an age dependency similar to that of SEBES.
SEBES 6c is more suitable for predicting outcome after SAH than SEBES. Furthermore, it predicts outcome and DI independently of vasospasm, so it can be used to differentiate between early brain injury- and vasospasm-dependent infarctions and outcome. However, SEBES and SEBES 6c are both age dependent and can be used for patients aged < 60 years and may have limited suitability for patients aged 60-69 years and no suitability for patients aged ≥ 70 years.
蛛网膜下腔出血早期脑水肿评分（SEBES）系统可在CT上测量脑水肿情况，并用于预测蛛网膜下腔出血（SAH）后的预后。作者开发了一种改良的SEBES（SEBES 6c），并评估其预测SAH后预后的能力是否优于SEBES。此外，他们还验证了这些评分的年龄依赖性。
在这项回顾性研究中，分析了2011年1月至2017年2月期间在单一机构就诊的所有动脉瘤性SAH患者。SEBES基于两个特定CT层面上脑沟不可见的情况（0 - 4分），而SEBES 6c则根据初始CT确定。SEBES 6c系统包括原始SEBES的两个层面以及顶点下方2 cm处的一个层面（0 - 6分）。作者研究了不同的SEBES是否存在年龄依赖性，以及它们能否预测延迟性梗死（DI）和预后。
261例患者符合研究纳入标准。与SEBES首次发表的研究结果一致，SEBES是DI（每增加1分，OR为1.6）和不良预后（每增加1分，OR为1.36）的独立预测指标。然而，作者在此发现SEBES存在年龄依赖性。在年龄小于60岁的组中，高分级SEBES（3 - 4分）的患者发生DI和不良预后的频率显著高于低分级（0 - 2分）的患者。在60 - 69岁和≥70岁的年龄组中，高分级和低分级评分之间在DI和预后方面未发现显著差异，尽管在60 - 69岁年龄组中，高分级SEBES的患者存在DI和不良预后的趋势。受试者工作特征曲线分析表明，SEBES 6c在预测预后方面比SEBES具有更高的预后价值（p < 0.001）。此外，SEBES 6c独立于血管痉挛可预测不良预后（每增加1分，OR为1.31）和DI（每增加1分，OR为1.36）。SEBES 6c显示出与SEBES相似的年龄依赖性。
与SEBES相比，SEBES 6c更适合预测SAH后的预后。此外，它独立于血管痉挛预测预后和DI，因此可用于区分早期脑损伤依赖性梗死与血管痉挛依赖性梗死及其预后。然而，SEBES和SEBES 6c均存在年龄依赖性，可用于年龄<60岁的患者，对于60 - 69岁的患者适用性可能有限，对于≥70岁的患者则不适用。
