Takenaka Tomofumi, Takagaki Masatoshi, Nakamura Hajime, Nishida Takeo, Taniguchi Masaaki, Tateishi Akihiro, Kobayashi Maki, Fukuya Shogo, Murakami Tomoaki, Shimizu Takeshi, Achiha Takamune, Matsui Yuichi, Yamada Shuhei, Fukuda Tatsumaru, Nakagawa Ryota, Matsumura Takaki, Nakata Hidekazu, Hoshikuma Yuhei, Toyota Shingo, Wakayama Akatsuki, Kishima Haruhiko
Department of Neurosurgery, Osaka University Graduate School of Medicine.
Department of Neurosurgery, Osaka Neurological Institute.
Neurol Med Chir (Tokyo). 2025 Jun 15;65(6):278-289. doi: 10.2176/jns-nmc.2024-0326. Epub 2025 Apr 7.
Early brain injury after a subarachnoid hemorrhage is an important prognostic factor. Aging is also an important prognostic factor of subarachnoid hemorrhage. However, the association between early brain injury and aging remains unclear. Older patients have comorbidities and frailty that can affect early brain injury severity. The purpose of this retrospective study was to clarify the differences in early brain injury severity between young and older patients by adjusting for comorbidities and frailty using propensity score matching. Between 2013 and 2021, 433 patients with subarachnoid hemorrhage who presented within 72 hrs of onset were included. The patients were divided into 2 groups: those aged 18-65 years (young group) and those aged ≥75 years (older group). The primary end point was early brain injury, which comprised the clinical, radiological, and laboratory findings on admission. We used propensity score matching to adjust for histories, comorbidities, and frailty. We analyzed early brain injury in the 2 groups for both non-propensity score matching and propensity score matching cohorts. Within the non-propensity score matching cohort, 260 patients were included in the young group and 173 in the older group. The propensity score matching cohort comprised 98 patients from both groups. The older group showed a higher World Federation of Neurosurgical Societies grade (p < 0.001), higher Hijdra scale (p < 0.01), and higher proportion of acute hydrocephalus (p < 0.001) in both cohorts. The study indicated exacerbated early brain injury among older patients, with worsening neurological damage, increasing subarachnoid hemorrhage volume, and causing hydrocephalus. Clarifying the impact of aging on early brain injury may help develop therapeutic interventions for subarachnoid hemorrhage.
蛛网膜下腔出血后的早期脑损伤是一个重要的预后因素。年龄也是蛛网膜下腔出血的一个重要预后因素。然而，早期脑损伤与年龄之间的关联仍不清楚。老年患者存在合并症和身体虚弱，这会影响早期脑损伤的严重程度。这项回顾性研究的目的是通过倾向评分匹配来调整合并症和身体虚弱情况，以阐明年轻患者和老年患者在早期脑损伤严重程度上的差异。在2013年至2021年期间，纳入了433例在发病72小时内就诊的蛛网膜下腔出血患者。患者被分为两组：18至65岁的患者（年轻组）和75岁及以上的患者（老年组）。主要终点是早期脑损伤，包括入院时的临床、影像学和实验室检查结果。我们使用倾向评分匹配来调整病史、合并症和身体虚弱情况。我们分析了非倾向评分匹配队列和倾向评分匹配队列中两组的早期脑损伤情况。在非倾向评分匹配队列中，年轻组纳入了260例患者，老年组纳入了173例患者。倾向评分匹配队列包括两组的98例患者。在两个队列中，老年组的世界神经外科协会分级更高（p<0.001），Hijdra量表评分更高（p<0.01），急性脑积水的比例更高（p<0.001）。该研究表明老年患者的早期脑损伤加剧，神经损伤加重，蛛网膜下腔出血量增加，并导致脑积水。阐明年龄对早期脑损伤的影响可能有助于开发蛛网膜下腔出血的治疗干预措施。
