van der Harst J Joep, Elting Jan Willem J, Bokkers Reinoud P H, Veeger Nic J G M, van Donkelaar Carlina E, van den Bergh Walter M, Metzemaekers Jan D M, Groen Rob J M, Mazuri Aryan, Luijckx Gert-Jan R, van Dijk J Marc C, Uyttenboogaart Maarten
Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
World Neurosurg. 2023 Oct;178:e202-e212. doi: 10.1016/j.wneu.2023.07.033. Epub 2023 Jul 15.
Near-infrared spectroscopy (NIRS) is a noninvasive tool to monitor cerebral regional oxygen saturation. Impairment of microvascular circulation with subsequent cerebral hypoxia during delayed cerebral ischemia (DCI) is associated with poor functional outcome after subarachnoid hemorrhage (SAH). Therefore, NIRS could be useful to predict the risk for DCI and functional outcome. However, only limited data are available on NIRS regional cerebral tissue oxygen saturation (rSO) distribution in SAH. The aim of this study was to compare the distribution of NIRS rSO values in patients with nontraumatic SAH with the occurrence of DCI and functional outcome at 2 months. In addition, the predictive value of NIRS rSO was compared with the previously validated SAFIRE grade (derived from Size of the aneurysm, Age, FIsher grade, World Federation of Neurosurgical Societies after REsuscitation).
In this study, the rSO distribution of patients with and without DCI after SAH was compared. The optimal cutoff points to predict DCI and outcome were assessed, and its predictive value was compared with the SAFIRE grade.
Of 41 patients, 12 developed DCI, and 9 had unfavorable outcome at 60 days. Prediction of DCI with NIRS had an area under the curve of 0.77 (95% confidence interval 0.62-0.92; P = 0.0028) with an optimal cutoff point of 65% (sensitivity 1.00; specificity 0.45). Prediction of favorable outcome with NIRS had an area under the curve of 0.86 (95% confidence interval 0.74-0.98; P = 0.0003) with an optimal cutoff point of 63% (sensitivity 1.00; specificity 0.63). Regression analysis showed that NIRS rSO score is complementary to the SAFIRE grade.
NIRS rSO monitoring in patients with SAH may improve prediction of DCI and clinical outcome after SAH.
近红外光谱技术（NIRS）是一种用于监测脑局部氧饱和度的非侵入性工具。在蛛网膜下腔出血（SAH）后的迟发性脑缺血（DCI）期间，微血管循环受损并随后出现脑缺氧，这与功能预后不良有关。因此，NIRS可能有助于预测DCI风险和功能预后。然而，关于SAH患者中NIRS局部脑组织氧饱和度（rSO）分布的可用数据有限。本研究的目的是比较非创伤性SAH患者的NIRS rSO值分布与DCI的发生情况以及2个月时的功能预后。此外，将NIRS rSO的预测价值与先前验证的SAFIRE分级（源自动脉瘤大小、年龄、Fisher分级、复苏后世界神经外科联合会分级）进行比较。
在本研究中，比较了SAH后发生和未发生DCI患者的rSO分布。评估预测DCI和预后的最佳截断点，并将其预测价值与SAFIRE分级进行比较。
41例患者中，12例发生DCI，9例在60天时预后不良。用NIRS预测DCI时曲线下面积为0.77（95%置信区间0.62 - 0.92；P = 0.0028），最佳截断点为65%（敏感性1.00；特异性0.45）。用NIRS预测良好预后时曲线下面积为0.86（95%置信区间0.74 - 0.98；P = 0.0003），最佳截断点为63%（敏感性1.00；特异性0.63）。回归分析表明，NIRS rSO评分与SAFIRE分级具有互补性。
对SAH患者进行NIRS rSO监测可能会改善对DCI和SAH后临床预后的预测。
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