Department of Neurosurgery, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
BMC Neurol. 2021 Dec 11;21(1):482. doi: 10.1186/s12883-021-02505-0.
The development of intraventricular hemorrhage (IVH) in aneurysmal subarachnoid hemorrhage (aSAH) is linked with higher mortality and poor neurological recovery. Previous studies have investigated the effect of the amount and distribution of the initial IVH on the prognosis of aSAH. However, no studies have assessed the relationship between the changes in IVH over time and the prognosis of aSAH. The aim of this study was to analyze the effect of the clearance rate of IVH, which can be represented by the IVH clot clearance rate (CCR), on the outcomes of aSAH.
The IVH CCR was calculated based on the difference between the initial and follow-up modified Graeb scores (mGS), which were assessed by initial and 7-day follow-up brain computed tomography, respectively. Poor functional outcome was defined as a modified Rankin Scale score of 3-6. Univariate and multivariable analyses were performed to assess the relationships between IVH CCR and other risk factors and the prognosis of patients. Receiver operating characteristic curve analysis was performed to identify cut-off values of IVH CCR for predicting poor functional outcome.
In total, 196 consecutive patients were diagnosed with aSAH between January 2014 and March 2018. According to the inclusion and exclusion criteria, 67 patients were finally included in the study. The univariate analysis revealed that a lower IVH CCR (p<0.001), higher initial mGS (p<0.001), older age (p<0.001), higher initial Hunt and Hess grade (p<0.001), presence of delayed infarction (p=0.03), and presence of shunt-dependent hydrocephalus (p=0.004) were significantly related to poor functional outcome. The multivariable analysis revealed that IVH CCR (odds ratio [OR] 0.941; p=0.029), initial mGS (OR 1.632; p=0.043), age (OR 1.561; p=0.007), initial Hunt and Hess grade (OR 227.296; p=0.030), and delayed infarction (OR 5310.632; p=0.023) were independent predictors of poor functional outcome. Optimal cut-off values of IVH CCR and mGS for poor outcome were 36.27%, and 13.5, respectively (all p< 0.001).
The IVH CCR might have an important predictive value on poor functional outcome in patients with aSAH and IVH, along with initial mGS, age, initial Hunt and Hess grade, and delayed infarction.
脑室内出血（IVH）的发展与颅内动脉瘤性蛛网膜下腔出血（aSAH）的死亡率和神经功能恢复不良有关。先前的研究已经探讨了初始 IVH 的量和分布对 aSAH 预后的影响。然而，尚无研究评估 IVH 随时间的变化与 aSAH 预后之间的关系。本研究旨在分析 IVH 清除率（可以用 IVH 血凝块清除率[CCR]表示）对 aSAH 结果的影响。
根据初始和 7 天随访脑计算机断层扫描（CT）评估的初始和改良 Graeb 评分（mGS）之间的差异计算 IVH CCR。功能预后不良定义为改良 Rankin 量表评分 3-6。采用单变量和多变量分析评估 IVH CCR 与其他危险因素及患者预后之间的关系。采用受试者工作特征曲线分析确定预测功能预后不良的 IVH CCR 截断值。
2014 年 1 月至 2018 年 3 月，共确诊 196 例连续的 aSAH 患者。根据纳入和排除标准，最终有 67 例患者纳入研究。单变量分析显示，IVH CCR 较低（p<0.001）、初始 mGS 较高（p<0.001）、年龄较大（p<0.001）、初始 Hunt 和 Hess 分级较高（p<0.001）、存在迟发性梗死（p=0.03）和存在分流依赖性脑积水（p=0.004）与功能预后不良显著相关。多变量分析显示，IVH CCR（比值比[OR]0.941；p=0.029）、初始 mGS（OR 1.632；p=0.043）、年龄（OR 1.561；p=0.007）、初始 Hunt 和 Hess 分级（OR 227.296；p=0.030）和迟发性梗死（OR 5310.632；p=0.023）是功能预后不良的独立预测因素。IVH CCR 和 mGS 预测不良结局的最佳截断值分别为 36.27%和 13.5，均为<0.001。
IVH CCR 可能与初始 mGS、年龄、初始 Hunt 和 Hess 分级以及迟发性梗死一起，对伴有 IVH 的 aSAH 患者的不良功能结局具有重要的预测价值。
