Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria.
Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria.
Clin Neurol Neurosurg. 2024 May;240:108253. doi: 10.1016/j.clineuro.2024.108253. Epub 2024 Mar 22.
Spontaneous intracerebral hemorrhage (SICH) of the elderly is a devastating form of stroke with a high morbidity and economic burden. There is still a limited understanding of the risk factors for an unfavorable outcome where a surgical therapy may be less meaningful. Thus, the aim of this study is to identify factors associated with unfavorable outcome and time to death in surgically treated elderly patients with SICH.
We performed a single-center retrospective study of 70 patients (age > 60 years) with SICH operated between 2008 and 2020. Functional outcome was assessed by modified Rankin Scale. Various clinical and neuroradiological variables including type of neurosurgical treatment, anatomical location of hemorrhage, volumetry and distribution of hemorrhage were assessed. Univariate and multivariate logistic regression models were performed. Length of stay (LOS) and hospital costs are presented.
The overall mortality (mean follow-up time of 22 months) in this study was 32/70 patients (45.71%), 30-days mortality was 8/70 (11.42%), and 12-months mortality was 22/70 (31.43%). Average LOS was 73.5 days with a median of 58, 766 € estimated in hospital costs per patient. Multivariate analysis for 12-months mortality was significant for intraventricular hemorrhage (IVH) (p = 0.007, HR = 1.021, 95% CI = 1.006 - 1.037). ROC analysis for 12-months mortality for IVH volume >= 7 cm presented an are under the curve of 0.658.
We identified IVH volume > 7 cm as an independent prognostic risk factor for mortality in elderly patients after SICH. This may help clinicians in decision-making for this critical and growing subgroup of patients.
老年人自发性脑出血（SICH）是一种具有高发病率和经济负担的毁灭性脑卒中形式。对于手术治疗意义不大的预后不良的风险因素，人们的了解仍然有限。因此，本研究旨在确定与接受手术治疗的老年 SICH 患者预后不良和死亡时间相关的因素。
我们对 2008 年至 2020 年间接受手术治疗的 70 例（年龄>60 岁）SICH 患者进行了单中心回顾性研究。采用改良 Rankin 量表评估功能结局。评估了各种临床和神经影像学变量，包括神经外科治疗类型、出血的解剖位置、出血量和出血分布。进行了单变量和多变量逻辑回归模型分析。呈现了住院时间（LOS）和住院费用。
本研究的总体死亡率（平均随访时间 22 个月）为 32/70 例（45.71%），30 天死亡率为 8/70 例（11.42%），12 个月死亡率为 22/70 例（31.43%）。平均 LOS 为 73.5 天，中位数为 58，每位患者的住院费用估计为 766 欧元。12 个月死亡率的多变量分析显示，脑室内出血（IVH）具有统计学意义（p = 0.007，HR = 1.021，95%CI = 1.006-1.037）。IVH 体积>=7cm 的 12 个月死亡率的 ROC 分析显示曲线下面积为 0.658。
我们发现 IVH 体积>7cm 是老年 SICH 患者死亡的独立预后危险因素。这可能有助于临床医生为这一关键且不断增长的患者亚组做出决策。
