Department of Neurosurgery (S.-Y.W., B.B., D.D., T.M.F., K.H., S.T., F.G.), University Medical Center Rostock, Germany.
Department of Neurosurgery (R.M., C.S., N.D.), Jena University Hospital, Germany.
Stroke. 2023 Oct;54(10):2569-2575. doi: 10.1161/STROKEAHA.123.043478. Epub 2023 Aug 8.
Several individual predictors for outcomes in patients with cerebellar stroke (CS) have been previously identified. There is, however, no established clinical score for CS. Therefore, the aim of this study was to develop simple and accurate grading scales for patients with CS in an effort to better estimate mortality and outcomes.
This multicentric retrospective study included 531 patients with ischemic CS presenting to 5 different academic neurosurgical and neurological departments throughout Germany between 2008 and 2021. Logistic regression analysis was performed to determine independent predictors related to 30-day mortality and unfavorable outcome (modified Rankin Scale score of 4-6). By weighing each parameter via calculation of regression coefficients, an ischemic CS-score and CS-grading scale (CS-GS) were developed and internally validated.
Independent predictors for 30-day mortality were aged ≥70 years (odds ratio, 5.2), Glasgow Coma Scale score 3 to 4 at admission (odds ratio, 2.6), stroke volume ≥25 cm (odds ratio, 2.7), and involvement of the brain stem (odds ratio, 3.9). When integrating each parameter into the CS-score, age≥70 years and brain stem stroke were assigned 2 points, Glasgow Coma Scale score 3 to 4, and stroke volume≥25 cm 1 point resulting in a score ranging from 0 to 6. CS-score of 0, 1, 2, 3, 4, 5, and 6 points resulted in 30-day mortality of 1%, 6%, 6%, 17%, 21%, 55%, and 67%, respectively. Independent predictors for 30-day unfavorable outcomes consisted of all components of the CS-score with an additional variable focused on comorbidities (CS-GS). Except for Glasgow Coma Scale score 3 to 4 at admission, which was assigned 3 points, all other parameters were assigned 1 point resulting in an overall score ranging from 0 to 7. CS-GS of 0, 1, 2, 3, 4, 5, 6, and 7 points resulted in 30-day unfavorable outcome of 1%, 17%, 33%, 40%, 50%, 80%, 77%, and 100%, respectively. Both 30-day mortality and unfavorable outcomes increased with increasing CS-score and CS-GS (<0.001).
The CS-score and CS-GS are simple and accurate grading scales for the prediction of 30-day mortality and unfavorable outcome in patients with CS. While the score systems proposed here may not directly impact treatment decisions, it may help discuss mortality and outcome with patients and caregivers.
先前已经确定了一些与小脑卒中（CS）患者结局相关的个体预测因素。然而，目前尚无针对 CS 的既定临床评分。因此，本研究旨在为 CS 患者开发简单且准确的分级量表，以更好地估计死亡率和结局。
本多中心回顾性研究纳入了 2008 年至 2021 年间在德国 5 个不同的神经外科和神经科学术部门就诊的 531 例缺血性 CS 患者。采用逻辑回归分析确定与 30 天死亡率和不良结局（改良 Rankin 量表评分 4-6）相关的独立预测因素。通过计算回归系数来为每个参数赋予权重，开发并内部验证了缺血性 CS 评分和 CS 分级量表（CS-GS）。
30 天死亡率的独立预测因素为年龄≥70 岁（比值比，5.2）、入院时格拉斯哥昏迷量表评分 3-4（比值比，2.6）、卒中量≥25cm（比值比，2.7）和脑干受累（比值比，3.9）。当将每个参数整合到 CS 评分中时，年龄≥70 岁和脑干卒中被赋予 2 分，格拉斯哥昏迷量表评分 3-4 分，卒中量≥25cm 分 1 分，得分为 0-6 分。CS 评分为 0、1、2、3、4、5 和 6 分，30 天死亡率分别为 1%、6%、6%、17%、21%、55%和 67%。30 天不良结局的独立预测因素包括 CS 评分的所有组成部分，以及另外一个与合并症相关的变量（CS-GS）。除入院时格拉斯哥昏迷量表评分 3-4 分被赋予 3 分外，其他所有参数均被赋予 1 分，总分为 0-7 分。CS-GS 评分为 0、1、2、3、4、5、6 和 7 分，30 天不良结局的发生率分别为 1%、17%、33%、40%、50%、80%、77%和 100%。CS 评分和 CS-GS 均与 30 天死亡率和不良结局呈正相关（<0.001）。
CS 评分和 CS-GS 是预测 CS 患者 30 天死亡率和不良结局的简单、准确的分级量表。虽然这里提出的评分系统可能不会直接影响治疗决策，但它可能有助于与患者和照护者讨论死亡率和结局。
