Burth Sina, Meis Jan, Kronsteiner Dorothea, Heckhausen Helena, Zweckberger Klaus, Kieser Meinhard, Wick Wolfgang, Ulfert Christian, Möhlenbruch Markus, Ringleb Peter, Schönenberger Silvia
Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Institute of Medical Biometry, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
Neurol Res Pract. 2023 Nov 2;5(1):57. doi: 10.1186/s42466-023-00283-3.
As a complication of subarachnoid hemorrhage (SAH), vasospasm substantially contributes to its morbidity and mortality. We aimed at analyzing predictors of outcome for these patients including the role of endovascular treatment (ET). Our database was screened for patients with SAH treated in our Neuro-ICU from 2009 to 2019. Clinical parameters including functional outcome (modified Rankin Scale, mRS of 0-2 or 3-6 at discharge and after a median follow-up of 18 months) and details about ET were gathered on 465 patients, 241 (52%) of whom experienced vasospasm. Descriptive analyses were performed to identify explanatory variables for the dichotomized mRS score. A logistic regression model was fitted on 241 patients with vasospasm including age, Hunt and Hess Score, extraventricular drainage (EVD), forced hypertension, ET and delayed cerebral ischemia (DCI). The model found a Hunt and Hess Score of 5 (OR = 0.043, p = 0.008), requirement of EVD (OR = 0.161, p < 0.001), forced hypertension (OR = 0.242, p = 0.001), ET (OR = 0.431, p = 0.043) and DCI (OR = 0.229, p < 0.001) to be negative predictors of outcome while age was not. Use of intraarterial nimodipine alone (OR = 0.778, p = 0.705) or including balloon angioplasty (OR = 0.894, p = 0.902) and number of ETs per patient (OR = 0.757, p = 0.416) were not significant in a separate model with otherwise identical variables. While DCI is clearly associated with poor outcome, the influence of ET on outcome remains inconclusive. Limited by their retrospective nature and an indication bias, these data encourage a randomized assessment of ET.
作为蛛网膜下腔出血（SAH）的一种并发症，血管痉挛在很大程度上导致了其发病率和死亡率。我们旨在分析这些患者的预后预测因素，包括血管内治疗（ET）的作用。我们筛查了2009年至2019年在我们神经重症监护病房接受治疗的SAH患者的数据库。收集了465例患者的临床参数，包括功能预后（改良Rankin量表，出院时及中位随访18个月后的mRS为0 - 2或3 - 6）以及ET的详细信息，其中241例（52%）发生了血管痉挛。进行描述性分析以确定二分法mRS评分的解释变量。对241例发生血管痉挛的患者建立了逻辑回归模型，包括年龄、Hunt和Hess评分、脑室外引流（EVD）、强制性高血压、ET和迟发性脑缺血（DCI）。该模型发现Hunt和Hess评分为5（OR = 0.043，p = 0.008）、需要EVD（OR = 0.161，p < 0.001）、强制性高血压（OR = 0.242，p = 0.001）、ET（OR = 0.431，p = 0.043）和DCI（OR = 0.229，p < 0.001）是预后的负性预测因素，而年龄不是。在一个具有其他相同变量的单独模型中，单独使用动脉内尼莫地平（OR = 0.778，p = 0.705）或包括球囊血管成形术（OR = 0.894，p = 0.902）以及每位患者的ET次数（OR = 0.757，p = 0.416）并不显著。虽然DCI显然与不良预后相关，但ET对预后的影响仍不确定。受其回顾性性质和指征偏倚的限制，这些数据鼓励对ET进行随机评估。
