Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil.
D ́Or Institute for Research and Education, Rio de Janeiro, Brazil.
Neurocrit Care. 2021 Aug;35(1):56-61. doi: 10.1007/s12028-020-01139-3. Epub 2020 Nov 4.
Acute physiologic derangements and multiple organ dysfunction are common after subarachnoid hemorrhage. We aimed to evaluate the simplified acute physiology score 3 (SAPS-3) and the sequential organ failure assessment (SOFA) scores for the prediction of in-hospital mortality in a large multicenter cohort of SAH patients.
This was a retrospective analysis of prospectively collected data from 45 ICUs in Brazil, during 2014 and 2015. Patients admitted with non-traumatic subarachnoid hemorrhage (SAH) were included. Clinical and outcome data were retrieved from an electronic ICU quality registry. SAPS-3 and SOFA scores, without the neurological components (i.e., nSAPS-3 and nSOFA, respectively) were recorded, as well as the World Federation of Neurological Surgeons (WFNS) scale. We used multilevel logistic regression analysis to identify factors associated with in-hospital mortality. We evaluated performance using the area under the receiver operating characteristic curve (AUROC), as well as calibration belts and precision-recall plots.
The study included 997 patients, from which 426 (43%) had poor clinical grade (WFNS 4 or 5) and in-hospital mortality was 34%. Median nSAPS-3 and nSOFA score at admission were 46 (IQR: 38-55) and 2 (0-5), respectively. Non-survivors were older, had higher nSAPS-3 and nSOFA, and more often poor grade. After adjustment for age, poor grade and withdrawal of life sustaining therapies, multivariable analysis identified nSAPS-3 and nSOFA score as independent clinical predictors of in-hospital mortality. The AUROC curve that included nSAPS-3 and nSOFA scores significantly improved the already good discrimination and calibration of age and WFNS to predict in-hospital mortality (AUROC: 0.89 for the full final model vs. 0.85 for age and WFNS; P < 0.0001).
nSAPS-3 and nSOFA scores were independently associated with in-hospital mortality after SAH. The addition of these scores improved early prediction of hospital mortality in our cohort and should be integrated to other specific prognostic indices in the early assessment of SAH.
蛛网膜下腔出血后常发生急性生理紊乱和多器官功能障碍。我们旨在评估简化急性生理学评分 3（SAPS-3）和序贯器官衰竭评估（SOFA）评分对巴西 45 个 ICU 中大量蛛网膜下腔出血（SAH）患者住院死亡率的预测价值。
这是一项对巴西 2014 年至 2015 年期间前瞻性收集的数据进行的回顾性分析。纳入的患者为非创伤性蛛网膜下腔出血（SAH）。从电子 ICU 质量登记处获取临床和结局数据。记录 SAPS-3 和 SOFA 评分（无神经学成分，即 nSAPS-3 和 nSOFA）以及世界神经外科学联合会（WFNS）分级。我们使用多水平逻辑回归分析确定与住院死亡率相关的因素。我们通过受试者工作特征曲线下面积（AUROC）评估性能，并绘制校准带和精度-召回图。
研究共纳入 997 例患者，其中 426 例（43%）临床分级较差（WFNS 4 或 5 级），住院死亡率为 34%。入院时的中位数 nSAPS-3 和 nSOFA 评分分别为 46（IQR：38-55）和 2（0-5）。非幸存者年龄较大，nSAPS-3 和 nSOFA 评分较高，且更常为较差的分级。在调整年龄、较差的分级和停止生命支持治疗后，多变量分析确定 nSAPS-3 和 nSOFA 评分是住院死亡率的独立临床预测因素。包含 nSAPS-3 和 nSOFA 评分的 AUROC 曲线显著提高了年龄和 WFNS 预测住院死亡率的良好区分度和校准度（AUROC：完整最终模型为 0.89，年龄和 WFNS 为 0.85；P<0.0001）。
nSAPS-3 和 nSOFA 评分与蛛网膜下腔出血后的住院死亡率独立相关。这些评分的加入改善了我们队列中对医院死亡率的早期预测，并且应该整合到蛛网膜下腔出血早期评估的其他特定预后指标中。
