Gomis P, Rousseaux P, Jolly D, Graftieaux J P
Département d'Anesthésie Réanimation, Hôpital Maison Blanche, CHU Reims.
Neurochirurgie. 1994;40(1):18-30.
The purpose of this retrospective study is to explain, using a total of 210 consecutive patients with aneurysmal subarachnoid hemorrhage, the survival by several prognostic factors measured at the admission time. A multivariate analysis using the Cox proportional hazards model allowed one to recognize five prognostic factors: secondary arterial hypertension (risk ratio (RR) = 1.8; p = 0.03), the Hunt and Hess grade-3 (RR = 3.3; p = 0.002), the Hunt and Hess grade-4 (RR = 7.3; p = 0.007), and the hunt and Hess grade-5 (RR = 5.8; p = 0.03), the Fisher grade-3 (RR = 2; p = 0.01), and the Fisher grade-4 (RR = 2; p = 0.001). The determination of a prognostic score for each patient (using the coefficients of selected prognostic factors) allowed one to establish 3 prognostic stages with survival probabilities significantly different (p = 0.00005); stage-1; survival rate after 150 days (SR) = 97 %, confidence interval of 95 % (CI) = [0.90; 0.99], stage-2: SR = 66 %, CI = [0.56; 0.74], stage-3; SR = 34 %, CI = [0.17; 0.54]. The relative death risk for the stage-2 was 14 times higher than that for stage-1 (p = 0.00005), and the relative death risk for the stage-3 was 36 times higher than that for stage-1 (p = 0.00005). The age, the essential arterial hypertension, the sex and the angiographic classification of George have no prognostic value. The rebleeding incidence was correlated with prognostic stages (respectively from stage-1 to the stage-3: 8 %, 14 %, 34 %).(ABSTRACT TRUNCATED AT 250 WORDS)
这项回顾性研究的目的是，通过对总共210例连续性动脉瘤性蛛网膜下腔出血患者进行分析，利用入院时测量的多个预后因素来解释其生存率。使用Cox比例风险模型进行多变量分析，确定了五个预后因素：继发性动脉高血压（风险比（RR）=1.8；p = 0.03）、Hunt和Hess 3级（RR = 3.3；p = 0.002）、Hunt和Hess 4级（RR = 7.3；p = 0.007）、Hunt和Hess 5级（RR = 5.8；p = 0.03）、Fisher 3级（RR = 2；p = 0.01）以及Fisher 4级（RR = 2；p = 0.001）。为每位患者确定预后评分（使用选定预后因素的系数），从而建立了3个预后阶段，其生存概率有显著差异（p = 0.00005）；1期：150天后生存率（SR）= 97%，95%置信区间（CI）= [0.90; 0.99]，2期：SR = 66%，CI = [0.56; 0.74]，3期：SR = 34%，CI = [0.17; 0.54]。2期的相对死亡风险比1期高14倍（p = 0.00005），3期的相对死亡风险比1期高36倍（p = 0.00005）。年龄、原发性动脉高血压、性别以及乔治血管造影分类均无预后价值。再出血发生率与预后阶段相关（分别从1期到3期：8%、14%、34%）。（摘要截断于250字）
