TY - JOUR
T1 - Loss of consciousness at ictus and/or poor World Federation of Neurosurgical Societies grade on admission reflects the impact of EBI and predicts poor outcome in patients with SAH
AU - Takahashi, Satoshi
AU - Akiyama, Takenori
AU - Horiguchi, Takashi
AU - Miwa, Tomoru
AU - Takemura, Ryo
AU - Yoshida, Kazunari
N1 - Publisher Copyright:
© 2020 Scientific Scholar. All rights reserved.
PY - 2020/3/6
Y1 - 2020/3/6
N2 - Background: There are many scores and markers that predict poor outcome in patients with subarachnoid hemorrhage (SAH). However, parameters that can predict outcomes in patients with SAH with high specificity and sensitivity, which can be identified in the early postictal state and utilized as a clinical marker of early brain injury (EBI) have not been identified so far. Methods: Thirty-nine patients with SAH due to a saccular intracranial aneurysm rupture were reviewed. We retrospectively analyzed the relationships between patients' baseline characteristics and patients' outcomes to identify parameters that could predict patient outcomes in the early postictal state. Results: In the univariate analysis, older age (>65), loss of consciousness (LOC) at ictus, poor initial World Federation of Neurosurgical Societies (WFNS) grade (3-5), and delayed cerebral ischemia (DCI) were associated with poor outcome (GOS 1-3). Statistical analyses revealed that combined LOC at ictus and/or poor initial WFNS grade (3-5) was a more powerful surrogate marker of outcome (OR 15.2 [95% CI 3.1-75.5]) than either LOC at ictus or the poor initial WFNS grade (3-5) alone. Multivariate logistic regression analyses revealed that older age, combined LOC at ictus and/or poor initial WFNS grade, and DCI were independently associated with poor outcome. Conclusion: Combined LOC at ictus and/or poor initial WFNS grade (3-5) reflects the impact of EBI and was a useful surrogate marker of poor prognosis in SAH patients, independent of patients' age and state of DCI.
AB - Background: There are many scores and markers that predict poor outcome in patients with subarachnoid hemorrhage (SAH). However, parameters that can predict outcomes in patients with SAH with high specificity and sensitivity, which can be identified in the early postictal state and utilized as a clinical marker of early brain injury (EBI) have not been identified so far. Methods: Thirty-nine patients with SAH due to a saccular intracranial aneurysm rupture were reviewed. We retrospectively analyzed the relationships between patients' baseline characteristics and patients' outcomes to identify parameters that could predict patient outcomes in the early postictal state. Results: In the univariate analysis, older age (>65), loss of consciousness (LOC) at ictus, poor initial World Federation of Neurosurgical Societies (WFNS) grade (3-5), and delayed cerebral ischemia (DCI) were associated with poor outcome (GOS 1-3). Statistical analyses revealed that combined LOC at ictus and/or poor initial WFNS grade (3-5) was a more powerful surrogate marker of outcome (OR 15.2 [95% CI 3.1-75.5]) than either LOC at ictus or the poor initial WFNS grade (3-5) alone. Multivariate logistic regression analyses revealed that older age, combined LOC at ictus and/or poor initial WFNS grade, and DCI were independently associated with poor outcome. Conclusion: Combined LOC at ictus and/or poor initial WFNS grade (3-5) reflects the impact of EBI and was a useful surrogate marker of poor prognosis in SAH patients, independent of patients' age and state of DCI.
KW - Early brain injury
KW - Loss of consciousness
KW - Outcome
KW - Subarachnoid hemorrhage
KW - World Federation of Neurosurgical Societies grade
UR - http://www.scopus.com/inward/record.url?scp=85086938095&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85086938095&partnerID=8YFLogxK
U2 - 10.25259/SNI_551_2019
DO - 10.25259/SNI_551_2019
M3 - Article
AN - SCOPUS:85086938095
SN - 2152-7806
VL - 11
JO - Surgical Neurology International
JF - Surgical Neurology International
IS - 40
M1 - 40
ER -