Identifying Patients at Increased Risk for Poor Outcomes Among Poor-Grade Aneurysmal Subarachnoid Hemorrhage Patients: The IPOGRO Risk Model.

IF 3 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Rustici Arianna, Scibilia Antonino, Linari Marta, Zoli Matteo, Zenesini Corrado, Belotti Laura Maria Beatrice, Sturiale Carmelo, Conti Alfredo, Aspide Raffaele, Castioni Carlo Alberto, Mazzatenta Diego, Princiotta Ciro, Dall'Olio Massimo, Bortolotti Carlo, Cirillo Luigi
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引用次数: 0

Abstract

Background: A subarachnoid hemorrhage due to an aneurysmal rupture (aSAH) is a serious condition with severe neurological consequences. The World Federation of Neurosurgical Societies (WFNS) classification is a reliable predictor of death and long-term disability in patients with aSAH. Poor-grade neurological conditions on admission in aSAH (PG-aSAH) are often linked to high mortality rates and unfavorable outcomes. However, more than one-third of patients with PG-aSAH may recover and have good functional outcomes if aggressive treatment is provided. We developed a risk model called Identifying POor GRade Outcomes (IPOGRO) to predict 6-month mRS outcomes in PG-aSAH patients as a secondary analysis of a previously published study.

Methods: All consecutive patients in poor-grade neurological conditions (WFNS IV-V) admitted to our institute from 2010 to 2020 due to aSAH were considered. Clinical and neuroradiological parameters were employed in the univariable analysis to evaluate the relationship with a 6-month modified Rankin Scale (mRS). Then, a multivariable multinomial regression model was performed to predict 6-month outcomes.

Results: 149 patients with PG-aSAH were included. Most patients were surgically treated, with only 33.6% being endovascularly treated. The 6-month mRS score was significantly associated with clinical parameters on admission, such as lowered Glasgow Coma Scale (GCS), leukocytosis, hyperglycemia, raised Systolic Blood Pressure (SBP), greater Simplified Acute Physiology Score (SAPS II score), increased initial serum Lactic Acid (LA) levels, and the need for Norepinephrine (NE) administration. Neuroradiological parameters on the initial CT scan showed a significant association with a worsening 6-month mRS. The IPOGRO risk model analysis showed an association between a WFNS V on admission and a poor outcome (mRS 4-5), while raised SBP was associated with mortality.

Conclusions: Our IPOGRO risk model indicates that PG-aSAH patients with higher SBP at admission had an increased risk of death at 6-month follow-up, whereas patients with WFNS grade V at admission had an increased risk of poor outcome but not mortality.

在劣度动脉瘤性蛛网膜下腔出血患者中识别出不良预后风险增加的患者:IPOGRO 风险模型。
背景:动脉瘤破裂导致的蛛网膜下腔出血(aSAH)是一种严重的疾病,会造成严重的神经系统后果。世界神经外科学会联合会(WFNS)的分级是预测蛛网膜下腔出血患者死亡和长期残疾的可靠指标。aSAH患者入院时神经系统状况较差(PG-aSAH)往往与高死亡率和不利的预后有关。然而,如果积极治疗,超过三分之一的 PG-aSAH 患者可以康复并获得良好的功能预后。我们建立了一个名为 "Identifying POor GRade Outcomes (IPOGRO) "的风险模型来预测 PG-aSAH 患者 6 个月的 mRS 结果,作为对之前发表的一项研究的二次分析:方法:研究对象为2010年至2020年期间我院收治的所有连续性低级别神经系统疾病(WFNS IV-V级)aSAH患者。临床和神经放射学参数被用于单变量分析,以评估与6个月改良Rankin量表(mRS)的关系。然后,采用多变量多项式回归模型预测6个月的结果:结果:共纳入149例PG-aSAH患者。大多数患者接受了手术治疗,只有33.6%的患者接受了血管内治疗。6个月的mRS评分与入院时的临床参数显著相关,如格拉斯哥昏迷量表(GCS)降低、白细胞增多、高血糖、收缩压(SBP)升高、简化急性生理学评分(SAPS II评分)升高、初始血清乳酸(LA)水平升高以及需要去甲肾上腺素(NE)给药。初次 CT 扫描的神经放射学参数与 6 个月 mRS 的恶化有显著关联。IPOGRO 风险模型分析显示,入院时的 WFNS V 与不良预后(mRS 4-5)有关,而 SBP 升高与死亡率有关:我们的 IPOGRO 风险模型显示,入院时 SBP 较高的 PG-aSAH 患者在 6 个月随访时死亡风险增加,而入院时 WFNS 分级为 V 的患者预后不佳的风险增加,但死亡率不增加。
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来源期刊
Journal of Personalized Medicine
Journal of Personalized Medicine Medicine-Medicine (miscellaneous)
CiteScore
4.10
自引率
0.00%
发文量
1878
审稿时长
11 weeks
期刊介绍: Journal of Personalized Medicine (JPM; ISSN 2075-4426) is an international, open access journal aimed at bringing all aspects of personalized medicine to one platform. JPM publishes cutting edge, innovative preclinical and translational scientific research and technologies related to personalized medicine (e.g., pharmacogenomics/proteomics, systems biology). JPM recognizes that personalized medicine—the assessment of genetic, environmental and host factors that cause variability of individuals—is a challenging, transdisciplinary topic that requires discussions from a range of experts. For a comprehensive perspective of personalized medicine, JPM aims to integrate expertise from the molecular and translational sciences, therapeutics and diagnostics, as well as discussions of regulatory, social, ethical and policy aspects. We provide a forum to bring together academic and clinical researchers, biotechnology, diagnostic and pharmaceutical companies, health professionals, regulatory and ethical experts, and government and regulatory authorities.
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