Xiao Zhen Kun, Wang Bing, Liu Jian Hua, Yang Yi Bo, Jie Niu, Mao Xing Yu, Gong Xin Yuan, Liu Ai Hua, Duan Yong Hong
Hengyang Key Laboratory of Hemorrhagic Cerebrovascular Disease, Department of Neurosurgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China.
Medical Teaching Experiment Center, Medical school, ShenZhen University, ShenZhen, GuangDong, China.
World Neurosurg. 2025 Jan;193:427-446. doi: 10.1016/j.wneu.2024.09.104. Epub 2024 Oct 18.
Aneurysmal subarachnoid hemorrhage (aSAH) is a common neurosurgical disorder with high morbidity and poor prognosis, and the associated delayed cerebral ischemia (DCI) is a key factor contributing to poor prognosis. Despite extensive research on the risk factors associated with DCI development, the evidence remains conflicting. Therefore, this meta-analysis of case-control studies aimed to investigate the risk factors for DCI occurrence during hospitalization in patients with aSAH.
We systematically searched PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials for eligible studies published before November 20, 2023. Two independent reviewers extracted relevant data from the included studies using a pre-established data extraction form. The primary outcome was DCI occurrence during hospitalization in patients with aSAH.
A total of 42 studies involving 21,726 patients with aSAH were included. The pooled meta-analysis showed that female sex; Hunt-Hess, modified Fisher, and World Federation of Neurosurgical Societies scale scores of 4-5, 3-4, and 4-5, respectively; vasospasm; combined intraventricular hemorrhage; pre-existing hypertension; hydrocephalus; intracranial infections; and high white blood cell count on admission were independent risk factors for the development of postoperative DCIs in patients with aSAH.
Patients with aSAH who have a Hunt-Hess scale score ≥4, a modified Fisher scale score ≥3, a WFNS scale score ≥4, intraventricular hemorrhage, pre-existing hypertension, cerebral vasospasm, a high white blood cell count on admission, intracranial infection, and female sex are at high risk of DCI and hence should be carefully monitored in the intensive care unit.
动脉瘤性蛛网膜下腔出血（aSAH）是一种常见的神经外科疾病，发病率高且预后较差，而与之相关的迟发性脑缺血（DCI）是导致预后不良的关键因素。尽管对与DCI发生相关的危险因素进行了广泛研究，但证据仍存在矛盾。因此，这项病例对照研究的荟萃分析旨在调查aSAH患者住院期间发生DCI的危险因素。
我们系统检索了PubMed、Embase、Web of Science和Cochrane对照试验中心注册库，以查找2023年11月20日前发表的符合条件的研究。两名独立的评审员使用预先制定的数据提取表从纳入的研究中提取相关数据。主要结局是aSAH患者住院期间发生DCI。
共纳入42项研究，涉及21726例aSAH患者。汇总的荟萃分析表明，女性；Hunt-Hess量表评分4-5分、改良Fisher量表评分3-4分、世界神经外科协会联盟（WFNS）量表评分4-5分；血管痉挛；合并脑室内出血；既往高血压；脑积水；颅内感染；以及入院时白细胞计数高是aSAH患者术后发生DCI的独立危险因素。
Hunt-Hess量表评分≥4分、改良Fisher量表评分≥3分、WFNS量表评分≥4分、脑室内出血、既往高血压、脑血管痉挛、入院时白细胞计数高、颅内感染以及女性的aSAH患者发生DCI的风险高，因此应在重症监护病房进行密切监测。
