Department of Neurosurgery, Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Neurology, Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Department of Neurosurgery, Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
World Neurosurg. 2020 Nov;143:e334-e343. doi: 10.1016/j.wneu.2020.07.127. Epub 2020 Jul 25.
The number of elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) admitted to intensive care units (ICUs) has increased. We aimed to analyze the characteristics and outcomes of such patients in a tertiary university hospital during a 5-year period.
A retrospective single-center analysis was performed of patients with aSAH ≥70 years old admitted to a tertiary neuro-ICU during January 2014-May 2019 based on medical records and computed tomography scans. The primary outcome was functional outcome at 12 months. We used multivariable logistic regression to assess factors associated with unfavorable outcome (Glasgow Outcome Scale score 1-3 and institutionalized).
Of 117 included patients, 49% had a favorable outcome at 12 months, and mortality was 41%. In multivariable analysis, poor-grade aSAH and intraventricular hemorrhage were predictors of poor outcome (odds ratio, 4.7, 95% confidence interval, 1.7-12.5 and odds ratio, 2.8, 95% confidence interval, 1.1-7.2, respectively). None of the patients with a Glasgow Coma Scale (GCS) motor score of 1-3 three days after admission was alive at 12 months. In contrast, 65% of those with a GCS motor score 6 had favorable outcome.
Half of elderly patients with aSAH admitted to a neuro-ICU were able to live at home after 12 months. Mortality was significant, but the number of severely disabled patients was low. Clinical status at admission was the strongest predictor of outcome, whereas intraventricular hemorrhage increased the risk of poor outcome as well. GCS motor score 3 days after admission seemed to predict mortality and outcome.
因颅内动脉瘤性蛛网膜下腔出血（aSAH）而入住重症监护病房（ICU）的老年患者数量有所增加。我们旨在分析 5 年内一家三级大学医院此类患者的特征和结局。
根据病历和计算机断层扫描，对 2014 年 1 月至 2019 年 5 月期间入住三级神经 ICU 的年龄≥70 岁的 aSAH 患者进行回顾性单中心分析。主要结局为 12 个月时的功能结局。我们使用多变量逻辑回归来评估与不良结局（格拉斯哥结局量表评分 1-3 和住院）相关的因素。
在 117 例纳入患者中，49%在 12 个月时预后良好，死亡率为 41%。在多变量分析中，严重程度分级和脑室内出血是不良结局的预测因素（比值比，4.7，95%置信区间，1.7-12.5 和比值比，2.8，95%置信区间，1.1-7.2）。入院后第 3 天格拉斯哥昏迷量表（GCS）运动评分 1-3 的患者无一例在 12 个月时存活。相比之下，65%GCS 运动评分 6 的患者预后良好。
入住神经 ICU 的老年 aSAH 患者中有一半在 12 个月后能够在家中生活。死亡率较高，但严重残疾患者人数较少。入院时的临床状况是结局的最强预测因素，而脑室内出血也增加了不良结局的风险。入院后第 3 天的 GCS 运动评分似乎可以预测死亡率和结局。
