Catapano Joshua S, Louie Christopher E, Lang Michael J, DiDomenico Joseph D, Whiting Alexander C, Labib Mohamed A, Cole Tyler S, Fredrickson Vance L, Cavalcanti Daniel D, Lawton Michael T
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA.
World Neurosurg. 2020 Jul;139:e406-e411. doi: 10.1016/j.wneu.2020.04.007. Epub 2020 Apr 15.
Aneurysmal subarachnoid hemorrhage (aSAH) is debilitating in elderly patients, but literature regarding this population is scarce, and clinical decision-making remains debated. Outcomes of elderly patients with aSAH stratified by age and clinical presentation were analyzed.
Patients treated for aSAH were retrospectively analyzed. Patients were trichotomized into a young cohort (aged <60 years [n = 268]) and 2 elderly cohorts (aged 60-65 years [n = 60] and ≥65 years [n = 77]). The elderly cohorts were analyzed by poor or good scores at presentation (Hunt and Hess [HH] score >3 vs. ≤3, respectively) and poor functional outcome (modified Rankin Scale score >2).
Of 137 elderly patients, 121 had a 6-year follow-up. The >65-year-olds (75% [52/69]) were more likely to have poor functional outcomes than the 60 to 65-year-olds (48% [25/52]) (odds ratio, 3.3; 95% confidence interval, 1.5-7.1; P = 0.002). Among those with an HH score ≤3 at presentation (n = 90), the >65-year-old cohort had poorer outcomes than the 60 to 65-year-old cohort at 6-year follow-up (69% [35/51] vs. 36% [14/39], respectively; odds ratio, 3.9; 95% confidence interval, 1.6-9.4; P = 0.003). Among patients with an HH score >3, no statistically significant differences in functional outcome were observed between the >65-year-old (n = 18) and 60 to 65-year-old (n = 13) cohorts.
Elderly patients with aSAH are at high risk for poor functional outcomes. However, among those presenting with good HH scores, younger-elderly patients (aged 60-65 years) tend to fare better than older-elderly patients (aged >65 years). Elderly patients presenting with high-grade aSAH fare poorly regardless of age, which can inform clinical decision-making and prognostication.
动脉瘤性蛛网膜下腔出血（aSAH）对老年患者危害极大，但针对该人群的文献较少，临床决策仍存在争议。分析了按年龄和临床表现分层的老年aSAH患者的预后。
对接受aSAH治疗的患者进行回顾性分析。患者被分为三组：年轻队列（年龄<60岁[n = 268]）和两个老年队列（年龄60 - 65岁[n = 60]和≥65岁[n = 77]）。通过入院时评分差或好（分别为Hunt和Hess[HH]评分>3 vs.≤3）以及功能预后差（改良Rankin量表评分>2）对老年队列进行分析。
137例老年患者中，121例进行了6年随访。≥65岁的患者（75%[52/69]）比60至65岁的患者（48%[25/52]）更有可能出现功能预后差（优势比，3.3；95%置信区间，1.5 - 7.1；P = 0.002）。在入院时HH评分≤3的患者中（n = 90），≥65岁队列在6年随访时的预后比60至65岁队列差（分别为69%[35/51] vs. 36%[14/39]；优势比，3.9；95%置信区间，1.6 - 9.4；P = 0.003）。在HH评分>3的患者中，≥65岁队列（n = 18）和60至65岁队列（n = 13）之间在功能预后方面未观察到统计学显著差异。
老年aSAH患者功能预后差的风险较高。然而，在入院时HH评分良好的患者中，年轻老年患者（年龄60 - 65岁）的预后往往比老年老年患者（年龄>65岁）更好。无论年龄大小，表现为高级别aSAH的老年患者预后都很差，这可为临床决策和预后判断提供参考。
