Suzuki Kaima, Sato Hiroki, Sorimachi Takatoshi, Fukuda Hitoshi, Ueba Tetsuya, Chin Masaki, Nakatomi Hirofumi, Shiokawa Yoshiaki, Ishikawa Tatsuya, Kawamata Takakazu, Nakahara Ichiro, Shimamura Norihito, Ohkuma Hiroki, Ichihara Nao, Kakizaki Shota, Murayama Yuichi, Toyoda Kazunori, Kurita Hiroki, Ikawa Fusao
Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan.
Department of Neurosurgery, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan.
Neurosurg Rev. 2025 May 30;48(1):466. doi: 10.1007/s10143-025-03638-3.
Older age and Fisher group scores predict poor outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, among aging societies, treatment indications and decisions in older patients with severe-grade aSAH (World Federation of Neurosurgical Societies [WFNS] grade IV or V) remain poorly understood. Therefore, we aimed to identify the risk factors associated with poor outcomes in non-older and older patients with severe-grade aSAH. We analyzed a database of patients with aSAH treated between April 2007 and December 2019 in Japan and divided them into either the non-older (< 75 years) or older group (age ≥ 75 years) to identify factors associated with poor outcomes (modified Rankin Scale score [mRS] 3-6) at discharge. The data analyzed included patient demographics, comorbidities, aneurysm characteristics, Fisher group, WFNS grade, treatment method, and mRS score at discharge. Among the 5,095 patients, 1,303 (986 non-older and 317 older) were classified as having severe-grade aSAH. In non-older patients, chronological age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.03-1.05) and Fisher groups 3 and 4 were associated with poor outcomes as compared with Fisher group 1 + 2 (OR, 2.98; 95% CI, 1.59-5.58 and OR, 5.49; 95% CI, 2.86-10.54, respectively). However, chronological age and Fisher groups 3 and 4 were not associated with poor outcomes in older patients with severe-grade aSAH. This study suggests that outcomes in older patients with severe-grade aSAH cannot be predicted in the same manner as in non-older patients. Further research on potential prognostic factors, such as biological age, is warranted. Clinical trial number Not applicable.
高龄和Fisher分级评分可预测动脉瘤性蛛网膜下腔出血（aSAH）患者的不良预后。然而，在老龄化社会中，老年重度aSAH患者（世界神经外科协会联盟[WFNS]分级IV级或V级）的治疗指征和决策仍知之甚少。因此，我们旨在确定非老年和老年重度aSAH患者不良预后的相关危险因素。我们分析了2007年4月至2019年12月在日本接受治疗的aSAH患者数据库，并将他们分为非老年组（<75岁）或老年组（年龄≥75岁），以确定出院时不良预后（改良Rankin量表评分[mRS] 3 - 6）的相关因素。分析的数据包括患者人口统计学、合并症、动脉瘤特征、Fisher分级、WFNS分级、治疗方法和出院时的mRS评分。在5095例患者中，1303例（986例非老年患者和317例老年患者）被分类为重度aSAH。在非老年患者中，与Fisher 1 + 2组相比，实际年龄（比值比[OR]，1.04；95%置信区间[CI]，1.03 - 1.05）以及Fisher 3级和4级与不良预后相关（分别为OR，2.98；95% CI，1.59 - 5.58和OR，5.49；95% CI，2.86 - 10.54）。然而，在老年重度aSAH患者中，实际年龄以及Fisher 3级和4级与不良预后无关。本研究表明，老年重度aSAH患者的预后不能以与非老年患者相同的方式预测。有必要对诸如生物学年龄等潜在预后因素进行进一步研究。临床试验编号不适用。
