Kurz Elena, Fassl Verena, Brockmann Carolin, Schulze Alicia, Kalasauskas Darius, Ringel Florian, Neulen Axel
Department of Neurosurgery, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany.
Department of Neuroradiology, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany.
Front Med (Lausanne). 2025 Jun 23;12:1580643. doi: 10.3389/fmed.2025.1580643. eCollection 2025.
Delayed cerebral ischemia (DCI)-associated infarctions are a major complication after spontaneous subarachnoid hemorrhage (SAH). Besides cerebral pathophysiological effects, peripheral organ dysfunction has been associated with DCI. The Sequential Organ Failure Assessment (SOFA) score is used in intensive care medicine to monitor organ failure. The objective of our study was to compare the SOFA score obtained in the first 48 h post-SAH, Hunt & Hess (HH), and World Federation of Neurosurgical Societies (WFNS) scores in predicting DCI-associated infarctions and to identify the most robust parameters within the SOFA score.
We retrospectively evaluated SOFA, H&H, and WFNS scores and DCI-associated infarctions in a cohort of 253 SAH patients.
The ROC analysis revealed an AUC of 0.65 for the SOFA score in predicting DCI-associated infarctions (H&H: 0.64, WFNS: 0.62). The threshold that maximized the sum of sensitivity and specificity was ≥7 points (sensitivity of 0.58, specificity of 0.68, PPV of 0.20, NPV of 0.92). A simplified score using only the three most robust parameters of the SOFA score, GCS, mean arterial pressure, and the Horovitz quotient, resulted in an AUC of 0.7.
The SOFA score predicted the development of DCI-associated infarctions similar to the established H&H and WFNS scores. A simplified score combining the three most robust parameters of the SOFA score was at least equal to the established scores. Therefore, the SOFA score and our simplified score could be used as an additional tool to identify SAH patients at high risk for DCI-associated infarctions.
延迟性脑缺血（DCI）相关梗死是自发性蛛网膜下腔出血（SAH）后的主要并发症。除了对大脑的病理生理影响外，外周器官功能障碍也与DCI有关。序贯器官衰竭评估（SOFA）评分用于重症医学中监测器官衰竭。我们研究的目的是比较SAH后48小时内获得的SOFA评分、Hunt & Hess（HH）评分和世界神经外科联合会（WFNS）评分在预测DCI相关梗死方面的情况，并确定SOFA评分中最可靠的参数。
我们回顾性评估了253例SAH患者队列中的SOFA、H&H和WFNS评分以及DCI相关梗死情况。
ROC分析显示，SOFA评分预测DCI相关梗死的AUC为0.65（HH：0.64，WFNS：0.62）。使敏感性和特异性之和最大化的阈值为≥7分（敏感性为0.58，特异性为0.68，阳性预测值为0.20，阴性预测值为0.92）。仅使用SOFA评分中三个最可靠参数（格拉斯哥昏迷量表（GCS）、平均动脉压和霍洛维茨商数）的简化评分，AUC为0.7。
SOFA评分预测DCI相关梗死的发生情况与既定的HH和WFNS评分相似。结合SOFA评分中三个最可靠参数的简化评分至少与既定评分相当。因此，SOFA评分和我们的简化评分可作为识别有DCI相关梗死高风险SAH患者的额外工具。
