Savi Marzia, Vitali Eva, Furlan Gaia, Faso Chiara, Demailly Zoe, Polato Martina, Degrassi Alessia, Damsceno Ana Carolina, de Magalhães Marcos Vinicius Tavares, Dumont Vinicius William Costa, Taccone Fabio Silvio, Bogossian Elisa Gouvêa
Department of Intensive Care, Neurosciences and Trauma Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust- Addenbrooke's Hospital, Cambridge, United Kingdom; Department of Intensive Care, Erasme Hospital, Brussels University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Department of Intensive Care, Erasme Hospital, Brussels University Hospital, Université Libre de Bruxelles, Brussels, Belgium; Department of Biomedical Science and Public Health, Università Politecnica delle Marche, Ancona, Italy.
Clin Neurol Neurosurg. 2025 Aug;255:108980. doi: 10.1016/j.clineuro.2025.108980. Epub 2025 May 25.
Early brain injury (EBI) following aneurysmal subarachnoid hemorrhage (aSAH) occurs in the first 3 days after bleeding is associated with long-term complications and poor neurological outcomes. The aim of this study was to externally validate the SHELTER score, which has been developed to quantify the severity of EBI.
This is a retrospective single center study of adult aSAH patients consecutively admitted to the Intensive Care Department of Hôpital Universitaire de Bruxelles between January 2015 and December 2023.We calculated the SHELTER score using data from the first 72 h after admission, including age, the World Federation of Neurological Surgeons grade, prehospital cardiopulmonary resuscitation, mydriasis, midline shift, early clinical deterioration, and early ischemia. Unfavorable functional outcome was defined as the modified Rankin scale 3-6 at 6 months.
We included 250 aSAH patients with a mean age of 55 (± 13) years. The SHELTER score demonstrated high predictive accuracy for unfavorable functional outcome with an area under the receiver operating characteristic of 0.80 [95 % confidence interval (CI) 0.75-0.86]. The optimal cut-off point for predicting unfavorable functional outcome was > 5.0, with a sensitivity of 0.57, specificity of 0.88, positive predictive value of 0.77 and negative predictive value of 0.75. In a multivariable analysis, the SHELTER score was independently associated with unfavorable functional outcome (OR 1.70, 95 % CI 1.37-2.10).
The SHELTER score can help identify aSAH patients at high risk of unfavorable functional outcome with good discriminative performance. This score could be used to better stratify patients in future studies investigating interventional strategies aiming at enhancing recovery and long-term prognosis after aSAH.
动脉瘤性蛛网膜下腔出血（aSAH）后的早期脑损伤（EBI）发生在出血后的头3天，与长期并发症和不良神经功能结局相关。本研究的目的是对外验证SHELTER评分，该评分已被开发用于量化EBI的严重程度。
这是一项对2015年1月至2023年12月期间连续入住布鲁塞尔大学医院重症监护科的成年aSAH患者进行的回顾性单中心研究。我们使用入院后前72小时的数据计算SHELTER评分，包括年龄、世界神经外科医师联盟分级、院前心肺复苏、瞳孔散大、中线移位、早期临床恶化和早期缺血。不良功能结局定义为6个月时改良Rankin量表评分为3 - 6分。
我们纳入了250例aSAH患者，平均年龄为55（±13）岁。SHELTER评分对不良功能结局具有较高的预测准确性，受试者工作特征曲线下面积为0.80[95%置信区间（CI）0.75 - 0.86]。预测不良功能结局的最佳截断点>5.0，敏感性为0.57，特异性为0.88，阳性预测值为0.77，阴性预测值为0.75。在多变量分析中，SHELTER评分与不良功能结局独立相关（OR 1.70，95%CI 1.37 - 2.10）。
SHELTER评分有助于识别具有不良功能结局高风险的aSAH患者，具有良好的鉴别性能。该评分可用于在未来研究中更好地对患者进行分层，这些研究旨在探讨旨在改善aSAH后恢复和长期预后的干预策略。
