Jamali Mohammad, Noorollahi Mahyar, Mohammad Hosseini Ehsan, Rahmanian Abdolkarim, Sayari Mohammad, Ghahramani Sulmaz
Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Mathematical Sciences and Research Methods Centre, Durham University, Durham DH13LE, UK.
Iran J Med Sci. 2025 Jul 1;50(7):445-454. doi: 10.30476/ijms.2024.102797.3589. eCollection 2025 Jul.
Decompressive craniectomy (DC) is effective in reducing mortality and improving outcomes in stroke patients. However, there is a need for a better understanding of the outcomes and complications of stroke, particularly in regions such as Iran, where comprehensive studies on DC outcomes are scarce. This study investigated the effects of DC in stroke patients.
This cohort study was conducted at Nemazi Hospital in Shiraz, Iran, from 2018 to 2020. All patients aged over 18 years with ischemic stroke requiring DC were included using census sampling. Data on demographics, clinical history, and imaging findings were collected. Outcomes were assessed using the modified rankin scale (mRS), Glasgow outcome score extended (GOSE), and aphasia severity rating (ASR).
A total of 144 cerebral infarction patients underwent DC; 22 (15.3%) were lost to follow-up, and 67 (55%) of the remaining patients died either during hospitalization or within at least 6 months of follow-up. Patients over 60 years old (OR=0.152), those with a history of stroke (OR=0.227), and those with COVID-19 infection (OR=0.164) were associated with a decreased likelihood of survival. However, an increase in the Glasgow Coma Scale (GCS) score on admission was associated with an increased probability of survival (OR=1.199). The ordered logistic regression analysis showed that an increase in GCS score was associated with a higher probability of achieving better outcomes across all models: GOSE (OR=1.177), mRS (OR=0.839, with lower scores indicating better outcomes), and ASR (OR=1.354). The analysis showed that patients over 60 had a lower probability of achieving better outcomes in the GOSE model (OR=0.185) and were likely to have worse outcomes in the mRS model (OR=5.182).
These findings underscored the critical role of comorbidities (such as COVID-19 and prior stroke) and GCS scores in predicting patient survival and functional outcomes following DC. In particular, the higher mortality rates and poorer functional outcomes observed in older patients highlighted the need for careful consideration in this age group.
减压性颅骨切除术（DC）在降低卒中患者死亡率和改善预后方面有效。然而，有必要更好地了解卒中的预后和并发症，尤其是在伊朗等地区，关于DC预后的全面研究较少。本研究调查了DC对卒中患者的影响。
本队列研究于2018年至2020年在伊朗设拉子的内马齐医院进行。采用普查抽样纳入所有年龄超过18岁、因缺血性卒中需要进行DC的患者。收集了人口统计学、临床病史和影像学检查结果的数据。使用改良Rankin量表（mRS）、格拉斯哥扩展预后评分（GOSE）和失语严重程度评分（ASR）评估预后。
共有144例脑梗死患者接受了DC；22例（15.3%）失访，其余患者中有67例（55%）在住院期间或至少随访6个月内死亡。60岁以上患者（OR=0.152）、有卒中病史患者（OR=0.227）和感染新冠病毒患者（OR=0.164）存活可能性降低。然而，入院时格拉斯哥昏迷量表（GCS）评分升高与存活概率增加相关（OR=1.199）。有序逻辑回归分析表明，在所有模型中，GCS评分升高与获得更好预后的概率更高相关：GOSE（OR=1.177）、mRS（OR=0.839，分数越低预后越好）和ASR（OR=1.354）。分析表明，60岁以上患者在GOSE模型中获得更好预后的概率较低（OR=0.185），在mRS模型中预后可能较差（OR=5.182）。
这些发现强调了合并症（如新冠病毒感染和既往卒中）和GCS评分在预测DC术后患者存活和功能预后方面的关键作用。特别是，老年患者中观察到的较高死亡率和较差功能预后凸显了对此年龄组进行仔细考虑的必要性。
