动脉瘤性蛛网膜下腔出血后存活的预测因素:长期观察队列研究

IF 1.8 4区 医学 Q3 CLINICAL NEUROLOGY Clinical Neurology and Neurosurgery Pub Date : 2024-10-20 DOI:10.1016/j.clineuro.2024.108605
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引用次数: 0

摘要

目的尽管近年来神经重症监护技术不断进步,但动脉瘤性蛛网膜下腔出血(SAH)患者的死亡率仍然相当高。在这项长期单中心观察性队列研究中,我们旨在分析 SAH 后死亡率的发生率、发生时间和预测因素。结果992例患者中有179例在初始治疗期间死亡,33例在随访期间死亡,总死亡率为21.4%。在超过 119 个测试变量中,我们在最终的多变量 Cox 回归分析中确定了以下独立预测因素:年龄 55 岁(p<0.0001);世界神经外科学会联合会(WFNS)入院分级 IV 级或 V 级(p=0.025);Hijdra 总分≥15 分(p=0.003);颅内压(ICP)升高(p<0.0001);延迟性脑缺血(DCI)(p<0.0001)。在中位生存期为 14 天的情况下,暴露于所有这五种风险因素的病例死亡率为 75%,而在中位生存期为 15-25 天的情况下,不存在这些特征的病例死亡率为 2.5%。在潜在的可预防不良事件中,初始治疗期间出现的 ICP 增高和 DCI 也对患者的长期随访生存具有重要的临床意义。进一步优化 ICP 和 DCI 管理可能有助于降低 SAH 后的死亡率。
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Predictors of survival after aneurysmal subarachnoid hemorrhage: The long-term observational cohort study

Objective

Despite recent advances in neuro-intensive care, there is still considerable mortality in patients with aneurysmal subarachnoid hemorrhage (SAH). In this long-term monocentric observational cohort study, we aimed to analyze the rates, timing, and predictors of mortality after SAH.

Methods

All consecutive SAH cases treated between January 2003 and June 2016 were included. Patients’ demographic characteristics, previous medical history, SAH-related parameters, and available post-treatment follow-up data were collected and evaluated as potential mortality predictors in univariate and multivariate analyses.

Results

Of 992 patients, 179 died during the initial treatment and 33 during the follow-up time reaching an overall mortality rate of 21.4 %. Of over 119 tested variables, we identified the following independent predictors in the final multivariate Cox regression analysis: age >55 years (p<0.0001); World Federation of Neurosurgical Societies (WFNS) admission grade IV or V (p=0.025); Hijdra sum score ≥15 points (p=0.003); intracranial pressure (ICP) increase (p<0.0001); and delayed cerebral ischemia (DCI) (p<0.0001). Being exposed to all five risk factors resulted in the case fatality rate of 75 % within a median survival of 14 days, compared to 2.5 % within a median of 1525 days when none of these features were present.

Conclusions

The initial impact of aneurysmal bleeding is amongst the major mortality causes after SAH. Of potentially preventable adverse events, ICP increase and DCI occurring during initial treatment also present eminent clinical relevance for patients’ survival in the long-term follow-up. Further ICP and DCI management optimization might help to decrease the mortality rate after SAH.
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来源期刊
Clinical Neurology and Neurosurgery
Clinical Neurology and Neurosurgery 医学-临床神经学
CiteScore
3.70
自引率
5.30%
发文量
358
审稿时长
46 days
期刊介绍: Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.
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