Renaudier Marie, Degos Vincent, Pisanu Gianluca, Granger Benjamin, Abdennour Lamine, Tabillon Caroline, Hijazi Dany, Boch Anne-Laure, Mathon Bertrand, Clarençon Frédéric, Shotar Eimad, Puybasset Louis, Bernard Rémy, Jacquens Alice
1Department of Anaesthesia and Critical Care, Pitié-Salpêtrière Hospital, Paris.
2Groupe de recherche clinique en anesthésie réanimation médecine périopératoire 29, Pitié-Salpêtrière Hospital, Paris.
J Neurosurg. 2025 May 23;143(3):615-623. doi: 10.3171/2025.2.JNS242210. Print 2025 Sep 1.
Subarachnoid hemorrhage (SAH) is a critical condition with high morbidity and mortality. Despite medical advances, predicting functional outcomes 1 year after the hemorrhage remains challenging. The aim of this study was to develop, compare, and validate a predictive score for 1-year functional outcomes after SAH.
This monocentric, retrospective observational study included all adults admitted to a neurosurgical ICU for aneurysmal SAH from 2002 to 2020, excluding moribund patients. The primary endpoint was a poor 1-year functional outcome, defined as a modified Rankin Scale score of 4 to 6. Independent risk factors for poor outcomes were identified using multivariate logistic regression in a derivation cohort. The predicting SAH long-term outcome (PSL) score was compared with the World Federation of Neurosurgical Societies (WFNS), Fisher, and admission bioclinical scores and validated in an independent cohort.
In the overall population (n = 1564), 21% experienced poor functional outcomes at 1 year. In the derivation cohort (n = 1095), independent predictors of poor outcomes included age (p < 0.001), WFNS score (p < 0.001), troponin level (p = 0.007), S100β level (p = 0.01), surgical or coiling complications (p < 0.001), incomplete aneurysm exclusion (p = 0.03), and hydrocephalus requiring CSF drainage (p = 0.002). The PSL score achieved an area under the receiver operating characteristic curve (ROC-AUC) of 0.85 (95% CI 0.82-0.88), outperforming other scores. These findings were consistent across various subgroups. In the validation cohort (n = 469), the PSL score achieved an ROC-AUC of 0.80 (95% CI 0.74-0.85), surpassing the WFNS and Fisher scores, with a negative predictive value of 95% (95% CI 94%-97%).
The authors developed a simple and effective score to identify predictors of poor 1-year functional outcomes at admission and early after aneurysmal SAH in a large cohort.
蛛网膜下腔出血（SAH）是一种发病率和死亡率都很高的危急病症。尽管医学不断进步，但预测出血后1年的功能结局仍然具有挑战性。本研究的目的是开发、比较和验证一种用于SAH后1年功能结局的预测评分。
这项单中心回顾性观察研究纳入了2002年至2020年因动脉瘤性SAH入住神经外科重症监护病房的所有成年人，不包括濒死患者。主要终点是1年功能结局不佳，定义为改良Rankin量表评分为4至6分。在一个推导队列中使用多因素逻辑回归确定不良结局的独立危险因素。将预测SAH长期结局（PSL）评分与世界神经外科协会联合会（WFNS）、Fisher评分及入院生物临床评分进行比较，并在一个独立队列中进行验证。
在总体人群（n = 1564）中，21%的患者在1年时功能结局不佳。在推导队列（n = 1095）中，不良结局的独立预测因素包括年龄（p < 0.001）、WFNS评分（p < 0.001）、肌钙蛋白水平（p = 0.007）、S100β水平（p = 0.01）、手术或栓塞并发症（p < 0.001）、动脉瘤未完全闭塞（p = 0.03）以及需要脑脊液引流的脑积水（p = 0.002）。PSL评分的受试者操作特征曲线下面积（ROC-AUC）为0.85（95%CI 0.82 - 0.88），优于其他评分。这些发现在各个亚组中都是一致的。在验证队列（n = 469）中，PSL评分的ROC-AUC为0.80（95%CI 0.74 - 0.85），超过了WFNS和Fisher评分，阴性预测值为95%（95%CI 94% - 97%）。
作者开发了一种简单有效的评分方法，用于在一个大型队列中识别动脉瘤性SAH入院时及早期1年功能结局不佳的预测因素。
