Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan.
Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
World Neurosurg. 2020 Sep;141:e466-e473. doi: 10.1016/j.wneu.2020.05.196. Epub 2020 May 29.
There is currently no precise guide for the treatment and management of elderly patients with aneurysmal subarachnoid hemorrhage (aSAH). Thus, the aim of this study was to clarify the factors of poor outcome and mortality in elderly patients with aSAH.
In the modified World Federation of Neurosurgical Societies (mWFNS) scale study, 1124 patients were divided into 2 groups, elderly (age ≥65 years) and non-elderly (age <65 years), with aSAH investigated between October 2010 and March 2013 in Japan. The odds ratio (OR) and 95% confidence interval (CI) of each risk factor was calculated through multivariate logistic regression analysis for poor outcomes, as indicated by the modified Rankin Scale (mRS) score ≥3 and mortality at 3 months after onset in each group.
Both groups demonstrated that the mWFNS scale was significant as a grade order risk factor for poor outcomes and mortality associated with disease. In the elderly group, risk factors for poor outcomes at 3 months after onset were older age (OR 1.10, 95% CI 1.06-1.14), male sex (OR 2.03, 95% CI 1.10-3.73), and severe cerebral vasospasm category (OR 10.13, 95% CI 4.30-23.87). Risk factors for mortality at 3 months after onset were older age (OR 1.06, 95% CI 1.01-1.11) and severe vasospasm category (OR 2.17, 95% CI 1.00-4.72).
The mWFNS scale is a useful prognostic predictor for both non-elderly and elderly patients with aSAH. Elderly male patients with aSAH presenting with severe vasospasm should be managed more carefully.
目前，对于老年动脉瘤性蛛网膜下腔出血（aSAH）患者的治疗和管理尚无精确的指南。因此，本研究旨在明确老年 aSAH 患者预后不良和死亡的相关因素。
在改良的世界神经外科医师联盟（mWFNS）分级研究中，1124 名患者被分为 2 组，老年（年龄≥65 岁）和非老年（年龄<65 岁）组，aSAH 患者于 2010 年 10 月至 2013 年 3 月在日本接受调查。通过多变量 logistic 回归分析计算每个风险因素的比值比（OR）和 95%置信区间（CI），以评估改良Rankin 量表（mRS）评分≥3 分的不良预后和发病后 3 个月的死亡率。
两组患者的 mWFNS 分级均为疾病不良预后和死亡率的显著分级风险因素。在老年组中，发病后 3 个月不良预后的危险因素为年龄较大（OR 1.10，95%CI 1.06-1.14）、男性（OR 2.03，95%CI 1.10-3.73）和严重脑动脉痉挛分类（OR 10.13，95%CI 4.30-23.87）。发病后 3 个月死亡的危险因素为年龄较大（OR 1.06，95%CI 1.01-1.11）和严重痉挛分类（OR 2.17，95%CI 1.00-4.72）。
mWFNS 分级对非老年和老年 aSAH 患者均是一种有用的预后预测指标。患有严重血管痉挛的老年男性 aSAH 患者应更谨慎地进行管理。
