预测特发性正常压力脑积水患者预后和长期死亡率的血管风险概况：临床决策支持工具的比较

Vascular risk profiles for predicting outcome and long-term mortality in patients with idiopathic normal pressure hydrocephalus: comparison of clinical decision support tools.

作者信息

Eklund Sanna A, Israelsson Hanna, Carlberg Bo, Malm Jan

机构信息

1Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden.

2Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; and.

出版信息

J Neurosurg. 2022 Jun 10;138(2):476-482. doi: 10.3171/2022.4.JNS22125. Print 2023 Feb 1.

DOI:10.3171/2022.4.JNS22125

PMID:35901765

Abstract

OBJECTIVE

Vascular risk factors (VRFs) may act synergistically, and clinical decision support tools (CDSTs) have been developed that present vascular risk as a summarized score. Because VRFs are a major issue in patients with idiopathic normal pressure hydrocephalus (INPH), a CDST may be useful in the diagnostic workup. The objective was to compare 4 CDSTs to determine which one most accurately predicts short-term outcome and 10-year mortality after CSF shunt surgery in INPH patients.

METHODS

One-hundred forty INPH patients who underwent CSF shunt surgery were included. For each patient, 4 CDST scores (Systematic Coronary Risk Evaluation-Older Persons [SCORE-OP], Framingham Risk Score [FRS], Revised Framingham Stroke Risk Profile, and Kiefer's Comorbidity Index [KCI]) were estimated. Short-term outcome (3 months after CSF shunt surgery) was defined on the basis of improvements in gait, Mini-Mental State Examination score, and modified Rankin Scale score. The 10-year mortality rate after surgery was noted. The CDSTs were compared by using Cox regression analysis, receiver operating characteristic curve analysis, and the chi-square test.

RESULTS

For 3 CDSTs, increased score was associated with increased risk of 10-year mortality. A 1-point increase in the FRS indicated a 2% higher risk of death within 10 years (HR 1.02, 95% CI 1.003-1.035, p = 0.021); SCORE-OP, 5% (HR 1.05, 95% CI 1.019-1.087, p = 0.002); and KCI, 12% (HR 1.12, 95% CI 1.03-1.219, p = 0.008). FRS predicted short-term outcome of surgery (p = 0.024). When the cutoff value was set to 32.5%, the positive predictive value was 80% and the negative predictive value was 48% (p = 0.012).

CONCLUSIONS

The authors recommend using FRS to predict short-term outcome and 10-year risk of mortality in INPH patients. The study indicated that extensive treatment of the risk factors of INPH may decrease risk of mortality. Clinical trial registration no.: NCT01850914 (ClinicalTrials.gov).

摘要

目的

血管危险因素（VRF）可能具有协同作用，现已开发出临床决策支持工具（CDST），可将血管风险以汇总分数的形式呈现。由于VRF是特发性正常压力脑积水（INPH）患者的主要问题，CDST可能有助于诊断检查。目的是比较4种CDST，以确定哪一种能最准确地预测INPH患者脑脊液分流手术后的短期结局和10年死亡率。

方法

纳入140例行脑脊液分流手术的INPH患者。为每位患者估算4种CDST评分（老年人系统性冠状动脉风险评估[SCORE-OP]、弗雷明汉姆风险评分[FRS]、修订的弗雷明汉姆卒中风险概况和基弗合并症指数[KCI]）。短期结局（脑脊液分流手术后3个月）根据步态、简易精神状态检查评分和改良Rankin量表评分的改善情况来定义。记录手术后的10年死亡率。使用Cox回归分析、受试者工作特征曲线分析和卡方检验对CDST进行比较。

结果

对于3种CDST，评分升高与10年死亡率风险增加相关。FRS增加1分表明10年内死亡风险高出2%（风险比1.02，95%置信区间1.003 - 1.035，p = 0.021）；SCORE-OP为5%（风险比1.05，95%置信区间1.019 - 1.087，p = 0.002）；KCI为12%（风险比1.12，95%置信区间1.03 - 1.219，p = 0.008）。FRS可预测手术的短期结局（p = 0.024）。当临界值设定为32.5%时，阳性预测值为80%，阴性预测值为48%（p = 0.012）。