Ritzenthaler Thomas, Gobert Florent, Balança Baptiste, Dailler Frederic
Service de Réanimation Neurologique, Hôpital Neurologique, Hospices Civils de Lyon, 59 Boulevard Pinel, 69677, Bron Cedex, France.
Équipe TIGER, U1028, UMR5292, Centre de Recherche en Neurosciences de Lyon, Université de Lyon, 69500, Bron, France.
Neurol Sci. 2023 Dec;44(12):4385-4390. doi: 10.1007/s10072-023-06945-z. Epub 2023 Jul 11.
Predicting the occurrence of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage is of interest to adjust the level of care. The VASOGRADE, a simple grading scale using admission World Federation of Neurosurgical Societies (WFNS) grading score and modified Fisher scale (mFS) on first CT scan, could help to select patients at risk of DCI. However, using data after initial resuscitation (initial complication treatment, aneurysm exclusion) may be more relevant.
We calculated a post-resuscitation VASOGRADE (prVG) using WFNS grade and mFS after early brain injury treatment and aneurysm exclusion (or at day 3). Patients were categorized as green, yellow, or red.
Using our prospective observational registry, 566 patients were included in the study. Two hundred six (36.4%) were classified as green, 208 (36.7%) as yellow, and 152 (26.9%) as red, and DCI was experienced in 22 (10.7%), 67 (32.2%), and 45 (29.6%) cases respectively. Patients classified as yellow had higher risk of developing DCI (OR 3.94, 95% CI 2.35-6.83). Risk was slightly lower in red patients (OR 3.49, 95% CI 2.00-6.24). The AUC for prediction was higher with prVG (0.62, 95% CI 0.58-0.67) than with VASOGRADE (0.56, 95% CI 0.51-0.60) (p < 0.01).
By using simple clinical and radiological scale evaluated at subacute stage, prVG is more accurate to predict the occurrence of DCI.
预测动脉瘤性蛛网膜下腔出血后迟发性脑缺血（DCI）的发生情况对于调整护理级别具有重要意义。VASOGRADE是一种简单的分级量表，它使用入院时世界神经外科联合会（WFNS）分级评分和首次CT扫描的改良Fisher量表（mFS），有助于筛选出有DCI风险的患者。然而，使用初始复苏后（初始并发症治疗、动脉瘤排除）的数据可能更具相关性。
我们在早期脑损伤治疗和动脉瘤排除后（或第3天），使用WFNS分级和mFS计算复苏后VASOGRADE（prVG）。患者被分为绿色、黄色或红色类别。
利用我们的前瞻性观察登记系统，566例患者纳入本研究。206例（36.4%）被分类为绿色，208例（36.7%）为黄色，152例（26.9%）为红色，分别有22例（10.7%）、67例（32.2%）和45例（29.6%）发生DCI。分类为黄色的患者发生DCI的风险更高（比值比3.94，95%置信区间2.35 - 6.83）。红色患者的风险略低（比值比3.49，95%置信区间2.00 - 6.24）。prVG预测的曲线下面积（AUC）（0.62，95%置信区间0.58 - 0.67）高于VASOGRADE（0.56，95%置信区间0.51 - 0.60）（p < 0.01）。
通过使用在亚急性期评估的简单临床和影像学量表，prVG能更准确地预测DCI的发生。
