Department of Neurosurgery and Spine Surgery, University Hospital of Essen, Essen, Germany.
Department of Diagnostic and Interventional Radiology, University Hospital of Essen, Essen, Germany.
Eur J Neurol. 2021 Dec;28(12):4051-4059. doi: 10.1111/ene.15033. Epub 2021 Aug 4.
The severity of early brain edema (EBE) after aneurysm rupture was reported to be strongly associated with the risk of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). Using the recently developed Subarachnoid Hemorrhage Early Brain Edema Score (SEBES), we analyzed the predictors of EBE and its impact on complications related to intracranial pressure (ICP) increase after SAH and on poor outcome.
All consecutive SAH cases treated between January 2003 and June 2016 with assessable SEBES were included (n = 745). Data on demographic characteristics, medical history, initial severity of SAH, need for conservative ICP treatment and decompressive craniectomy, occurrence of cerebral infarctions and unfavorable outcome at 6 months (modified Rankin scale score > 2) were collected. Univariable and multivariable analyses were performed.
Younger age (<55 years; adjusted odds ratio [aOR] 3.16, 95% confidence interval [CI] 2.28-4.38), female sex (aOR 1.64, 95% CI 1.16-2.31), poor initial clinical condition (World Federation of Neurosurgical Societies score 4-5; aOR 1.74, 95% CI 1.23-2.46), presence of intracerebral hemorrhage (aOR 1.63, 95% CI 1.12-2.36), hypothyroidism (aOR 0.60, 95% CI 0.37-0.98) and renal comorbidity (aOR 0.29, 95% CI 0.11-0.78) were independently associated with SEBES (scores 3-4). There was an independent association between SEBES 3-4 and the need for conservative ICP treatment (aOR 2.43, 95% CI 1.73-3.42), decompressive craniectomy (aOR 2.68, 95% CI 1.84-3.89), development of cerebral infarcts (aOR 2.24, 95% CI 1.53-3.29) and unfavorable outcome (aOR 1.48, 95% CI 1.0-2.17).
SEBES is a reliable predictor of ICP-related complications and poor outcome of SAH. Our findings highlight the need for further research of the impact of patients' demographic characteristics and comorbidities on the severity of EBE after SAH.
有研究报道，动脉瘤破裂后早期脑水肿（EBE）的严重程度与蛛网膜下腔出血（SAH）后不良预后的风险密切相关。我们使用最近开发的蛛网膜下腔出血早期脑水肿评分（SEBES）分析了 EBE 的预测因素及其对与颅内压（ICP）升高相关的并发症以及对不良预后的影响。
我们纳入了 2003 年 1 月至 2016 年 6 月间连续收治的、SEBES 可评估的所有 SAH 病例（n=745）。收集了人口统计学特征、病史、SAH 初始严重程度、是否需要保守 ICP 治疗和去骨瓣减压术、脑梗死的发生情况以及 6 个月时的不良预后（改良 Rankin 量表评分>2）的数据。进行了单变量和多变量分析。
年龄较小（<55 岁；调整后的优势比[aOR]3.16，95%置信区间[CI]2.28-4.38）、女性（aOR 1.64，95%CI 1.16-2.31）、初始临床状况较差（世界神经外科学会评分 4-5；aOR 1.74，95%CI 1.23-2.46）、存在脑内出血（aOR 1.63，95%CI 1.12-2.36）、甲状腺功能减退（aOR 0.60，95%CI 0.37-0.98）和肾脏合并症（aOR 0.29，95%CI 0.11-0.78）与 SEBES（评分 3-4）独立相关。SEBES 3-4 与需要保守 ICP 治疗（aOR 2.43，95%CI 1.73-3.42）、去骨瓣减压术（aOR 2.68，95%CI 1.84-3.89）、脑梗死的发生（aOR 2.24，95%CI 1.53-3.29）和不良预后（aOR 1.48，95%CI 1.0-2.17）独立相关。
SEBES 是 ICP 相关并发症和 SAH 不良预后的可靠预测因子。我们的研究结果强调需要进一步研究患者的人口统计学特征和合并症对 SAH 后 EBE 严重程度的影响。
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