Lampmann Tim, Hadjiathanasiou Alexis, Asoglu Harun, Wach Johannes, Kern Tamara, Vatter Hartmut, Güresir Erdem
Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany.
J Clin Med. 2022 Aug 15;11(16):4753. doi: 10.3390/jcm11164753.
Acute kidney injury (AKI) is a known predictor of unfavorable outcome in patients treated at the ICU, irrespective of the disease. However, data on the potential influence of serum creatinine (sCr) on hospital admission on the outcome in patients suffering from aneurysmal subarachnoid hemorrhage (SAH) is scarce. A total of 369 consecutive patients suffering from SAH were included in this retrospective cohort study. Patients were divided into good-grade (WFNS I−III) versus poor-grade (WFNS IV−V). Outcome was assessed according to the modified Rankin Scale (mRS) after 6 months and stratified into favorable (mRS 0−2) versus unfavorable (mRS 3−6). SAH patients with sCr levels <1.0 mg/dL achieved significantly a favorable outcome more often compared to patients with sCr levels ≥1.0 mg/dL (p = 0.003). In the multivariable analysis, higher levels of sCr (p = 0.014, OR 2.4; 95% CI 1.2−4.7), poor-grade on admission (p < 0.001, OR 9.8; 95% CI 5.6−17.2), age over 65 years (p < 0.001, OR 3.3; 95% CI 1.7−6.1), and delayed cerebral ischemia (p < 0.001, OR 7.9; 95% CI 3.7−17.1) were independently associated with an unfavorable outcome. We identified increased sCr on admission as a predictor for unfavorable functional outcome after SAH. Further studies elucidating the pathophysiology of this association are necessary.
急性肾损伤（AKI）是重症监护病房（ICU）患者不良预后的已知预测指标，无论其患有何种疾病。然而，关于血清肌酐（sCr）在动脉瘤性蛛网膜下腔出血（SAH）患者入院时对预后的潜在影响的数据却很匮乏。本回顾性队列研究共纳入了369例连续的SAH患者。患者被分为病情分级良好（世界神经外科医师联盟（WFNS）分级I - III级）和病情分级较差（WFNS分级IV - V级）两组。6个月后根据改良Rankin量表（mRS）评估预后，并分为预后良好（mRS 0 - 2）和预后不良（mRS 3 - 6）。与sCr水平≥1.0 mg/dL的患者相比，sCr水平<1.0 mg/dL的SAH患者更常获得良好的预后（p = 0.003）。在多变量分析中，较高的sCr水平（p = 0.014，比值比（OR）2.4；95%置信区间（CI）1.2 - 4.7）、入院时病情分级较差（p < 0.001，OR 9.8；95% CI 5.6 - 17.2）、年龄超过65岁（p < 0.001，OR 3.3；95% CI 1.7 - 6.1）以及迟发性脑缺血（p < 0.001，OR 7.9；95% CI 3.7 - 17.1）均与不良预后独立相关。我们发现入院时sCr升高是SAH后不良功能预后的一个预测指标。有必要进行进一步的研究以阐明这种关联的病理生理学机制。
