Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
World Neurosurg. 2022 Aug;164:e1214-e1225. doi: 10.1016/j.wneu.2022.05.140. Epub 2022 Jun 8.
The objective of the study was to clarify the prevalence of and factors associated with changes in patients' outcomes between discharge and 3 months after the onset of aneurysmal subarachnoid hemorrhage (aSAH). Additionally, the World Federation of Neurosurgical Societies (WFNS) and modified WFNS (mWFNS) scales were compared.
The data of curatively treated patients with aSAH, collected prospectively in the mWFNS scale study between January 2010 and December 2012, were analyzed retrospectively. The improvement or decline in the modified Rankin Scale (mRS) scores between discharge and 3 months after onset was determined. A multivariable logistic regression analysis was performed to identify factors, such as age and WFNS and mWFNS grades, associated with changes in the outcome.
The mRS scores improved in 28.3% and declined in 2.5% of the patients. WFNS and mWFNS grades Ⅱ-V on admission were significantly associated with improved mRS scores at 3 months after onset. Older age (age: 65-74 years vs. age <65 years, odds ratio: 6.59, 95% confidence interval: 1.28-34.01; age ≥75 years vs. age <65 years, odds ratio: 17.67, 95% confidence interval: 2.11-148.26) and WFNS grade III were significantly associated with a decline in mRS scores at 3 months after onset.
The optimal timing for postdischarge assessment of outcomes may be at 3 months after onset, especially in older patients with aSAH. The mWFNS scale is presumed to more accurately assess the outcomes of patients with aSAH than the WFNS scale, as demonstrated in this study.
本研究旨在阐明动脉瘤性蛛网膜下腔出血（aSAH）发病后出院至 3 个月时患者结局变化的流行情况及相关因素。此外，还对世界神经外科学会联合会（WFNS）和改良 WFNS（mWFNS）分级进行了比较。
回顾性分析 2010 年 1 月至 2012 年 12 月前瞻性纳入 mWFNS 分级研究的 aSAH 患者的临床资料。确定改良 Rankin 量表（mRS）评分在出院至发病后 3 个月时的改善或下降情况。采用多变量逻辑回归分析，明确年龄和 WFNS、mWFNS 分级等与结局变化相关的因素。
出院时 28.3%的患者 mRS 评分改善，2.5%的患者 mRS 评分恶化。入院时 WFNS 和 mWFNS 分级Ⅱ-Ⅴ级与发病后 3 个月 mRS 评分改善显著相关。年龄较大（65-74 岁 vs. <65 岁，优势比：6.59，95%置信区间：1.28-34.01；≥75 岁 vs. <65 岁，优势比：17.67，95%置信区间：2.11-148.26）和 WFNS 分级Ⅲ级与发病后 3 个月 mRS 评分恶化显著相关。
对 aSAH 患者出院后结局的最佳评估时间可能为发病后 3 个月，尤其是年龄较大的患者。本研究表明，mWFNS 分级较 WFNS 分级更能准确评估 aSAH 患者的结局。
