Wu Botao, Huang Zhe, Liu Huan, He Jiayao, Ju Yan, Chen Ziwei, Zhang Taiwei, Yi Fuxin
Department of Neurosurgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China.
Department of Radiology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China.
Front Neurol. 2022 Aug 12;13:963624. doi: 10.3389/fneur.2022.963624. eCollection 2022.
The long-term survival prognosis of patients with high-grade (Hunt-Hess grade IV-V or World Federation of Neurosurgical Societies grade IV-V) aneurysmal subarachnoid hemorrhage (aSAH) is generally poor, and the association between endovascular treatment timing and the prognosis of high-grade aSAH has not been explored in depth. This retrospective cohort study aimed to determine whether endovascular treatment within 24 h of high-grade aSAH is associated with a better prognosis.
We retrospectively analyzed the clinical data of patients with high-grade aSAH who were admitted to our institution between January 2018 and January 2021. The Modified Rankin Scale score was used to assess the 6-month prognosis of patients. Univariate and multivariate logistic regression analyses were used to identify the factors associated with prognosis. The area under the receiver operating characteristic (ROC) curve was used to assess the model's discriminatory ability.
Eighty-six patients were included in the study. In the multivariate analysis, the timing of endovascular treatment (odds ratio = 7.003 [1.800-27.242], = 0.005) was an independent risk factor for prognosis. The ROC curve showed that the predictive power of the timing of endovascular treatment was 0.744, the best cut-off value was 12.5 h, and the corresponding sensitivity and specificity were 71.4 and 70.5%, respectively. Hydrocephalus ( = 0.005) and pulmonary infection ( = 0.029) were also associated with prognosis. In addition, cerebrospinal fluid drainage immediately after endovascular treatment had a significant effect on reducing hydrocephalus formation.
Endovascular therapy within 24 h is feasible and improves the prognosis of patients with high-grade aSAH.
高级别（Hunt-Hess分级IV-V级或世界神经外科联合会分级IV-V级）动脉瘤性蛛网膜下腔出血（aSAH）患者的长期生存预后通常较差，且血管内治疗时机与高级别aSAH预后之间的关联尚未得到深入探讨。这项回顾性队列研究旨在确定高级别aSAH发病24小时内进行血管内治疗是否与更好的预后相关。
我们回顾性分析了2018年1月至2021年1月期间入住我院的高级别aSAH患者的临床资料。采用改良Rankin量表评分评估患者的6个月预后。采用单因素和多因素逻辑回归分析确定与预后相关的因素。采用受试者操作特征（ROC）曲线下面积评估模型的辨别能力。
86例患者纳入研究。多因素分析中，血管内治疗时机（比值比=7.003[1.800-27.242]，P=0.005）是预后的独立危险因素。ROC曲线显示，血管内治疗时机的预测能力为0.744，最佳截断值为12.5小时，相应的敏感度和特异度分别为71.4%和70.5%。脑积水（P=0.
