Berek Klaus, Lindner Anna, Kindl Philipp, Di Pauli Franziska, Schiefecker Alois J, Pfausler Bettina, Helbok Raimund, Deisenhammer Florian, Beer Ronny, Rass Verena, Hegen Harald
Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Department of Neurology, Johannes Kepler University, Linz, Austria.
Eur J Neurol. 2025 Jan;32(1):e16456. doi: 10.1111/ene.16456. Epub 2024 Oct 30.
Prognostication in patients with spontaneous subarachnoid hemorrhage (SAH) can be challenging. The aim of this study was to assess whether cerebrospinal fluid (CSF) red blood cell (RBC) count and total protein (TP) concentration are associated with SAH prognosis.
Patients with SAH treated at the neurological intensive care unit (ICU) in Innsbruck were included in this real-world, observational study. Longitudinal CSF samples were collected as part of routine diagnostics. RBC count and CSF TP at the time of admission (RBC, TP), in Week 1 (RBC, TP), Week 2 (RBC, TP), and Week 3 or thereafter (RBC, TP), the highest detected value (RBC, TP), as well as the RBC count adjusted for disease duration (RBC) were assessed. Primary outcomes were good functional outcome after 3 months, defined as modified Rankin scale score ≤2 and ICU survival.
A total of 183 SAH patients with a female predominance (69%), a median (interquartile range [IQR]) age of 60 (50-70) years and median (IQR) Hunt and Hess score of 4 (3-5) were included. Multivariable analyses revealed that lower values of RBC, RBC, RBC, TP and TP were associated with good functional outcome and hospital survival. Lower TP concentrations in Weeks 1, 2 and 3 were associated with good functional outcome, and in Weeks 1 and 2 with ICU survival. Early RBC measurements (Week 1) were associated with good functional outcome and ICU survival.
Low CSF RBC counts and TP concentrations were associated with good functional outcome and ICU survival in a real-world cohort of SAH patients requiring external ventricular drainage.
自发性蛛网膜下腔出血（SAH）患者的预后评估具有挑战性。本研究旨在评估脑脊液（CSF）红细胞（RBC）计数和总蛋白（TP）浓度是否与SAH预后相关。
纳入在因斯布鲁克神经重症监护病房（ICU）接受治疗的SAH患者进行这项真实世界的观察性研究。作为常规诊断的一部分，收集纵向脑脊液样本。评估入院时（RBC、TP）、第1周（RBC、TP）、第2周（RBC、TP）以及第3周或之后（RBC、TP）的RBC计数和脑脊液TP、最高检测值（RBC、TP），以及根据病程调整后的RBC计数（RBC）。主要结局为3个月后良好的功能结局，定义为改良Rankin量表评分≤2以及ICU存活。
共纳入183例SAH患者，以女性为主（69%），中位（四分位间距[IQR]）年龄为60（50 - 70）岁，中位（IQR）Hunt和Hess评分为4（3 - 5）。多变量分析显示，较低的RBC、RBC、RBC、TP和TP值与良好的功能结局和医院存活相关。第1周、第2周和第3周较低的TP浓度与良好的功能结局相关，第1周和第2周与ICU存活相关。早期RBC测量值（第1周）与良好的功能结局和ICU存活相关。
在需要进行脑室外引流的SAH患者的真实世界队列中，脑脊液低RBC计数和TP浓度与良好的功能结局和ICU存活相关。
