Influence of laboratory and radiographic parameters on the clinical presentation and outcome of surgically treated patients with primary brain abscesses

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Acta Neurochirurgica Pub Date : 2025-05-15 DOI:10.1007/s00701-025-06559-8

Adrian Liebert, Thomas Eibl, Dimitri Lukin, Ralph Bertram, Joerg Steinmann, Karl-Michael Schebesch, Leonard Ritter

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引用次数: 0

Abstract

Background

Brain abscesses can lead to severe clinical outcomes, including death. Most studies on brain abscesses focus either on patient cohorts including postsurgical/posttraumatic abscesses. This study aimed to assess the clinical presentation and postoperative outcomes in a homogeneous group of patients with primary, pyogenic brain abscesses who underwent surgical treatment.

Methods

We retrospectively analyzed consecutive patients with pyogenic brain abscesses treated surgically at our center from 2008 to 2023. The primary endpoint was a modified Rankin Scale (mRS) score of ≥ 3 at discharge. Secondary endpoint was preoperative clinical status (mRS ≥ 3). We statistically correlated clinical, radiographic, and microbiological parameters with these endpoints.

Results

A total of 60 patients (36.7% female) with a mean age of 48.5 ± 20.8 years were included in this study. Six patients (10.0%) had an unfavorable postoperative outcome, including two deaths (3.3%). Significant risk factors for poor outcomes included preoperative disturbance of consciousness (DOC) (p = 0.012) and elevated preoperative C-reactive protein (CRP) levels (p = 0.002). Larger abscess volume (37.4 mL vs. 16.1 mL, p = 0.065) and shorter mean distance to the ventricles (3 mm vs. 11.42 mm, p = 0.086) trended toward significance. The length of intensive care unit (ICU) stay was significantly longer for patients with unfavorable outcomes (p = 0.001). Upon admission, eighteen patients (30.0%) had an mRS score of ≥ 3. Elevated leukocyte count was identified as a significant risk factor for poor preoperative status (p = 0.007). Median clinical performance, measured by mRS, improved throughout the treatment course and during follow-up from 2 to 0.

Conclusions

Preoperative DOC and elevated CRP levels were identified as predictors of unfavorable outcomes. Elevated leukocyte count was a predictor for poor preoperative status.

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实验室和影像学参数对手术治疗原发性脑脓肿患者临床表现和预后的影响

脑脓肿可导致严重的临床结果，包括死亡。大多数关于脑脓肿的研究都集中在包括术后/创伤后脓肿的患者群体上。本研究旨在评估一组接受手术治疗的原发性化脓性脑脓肿患者的临床表现和术后结果。方法回顾性分析2008年至2023年在本中心连续接受手术治疗的化脓性脑脓肿患者。主要终点是出院时修改的Rankin量表（mRS）评分≥3分。次要终点为术前临床状态（mRS≥3）。我们将临床、放射学和微生物学参数与这些终点进行统计学关联。结果共纳入60例患者，女性36.7%，平均年龄48.5±20.8岁。6例患者（10.0%）术后预后不良，包括2例死亡（3.3%）。预后不良的重要危险因素包括术前意识障碍（DOC）（p = 0.012）和术前c反应蛋白（CRP）水平升高（p = 0.002）。更大的脓肿体积（37.4 mL vs. 16.1 mL, p = 0.065）和更短的平均距离心室（3 mm vs. 11.42 mm, p = 0.086）具有显著性。结果不良的患者在重症监护病房（ICU）的住院时间明显更长（p = 0.001）。入院时，18例患者（30.0%）mRS评分≥3分。白细胞计数升高被认为是术前不良状态的重要危险因素（p = 0.007）。用mRS测量的中位临床表现在整个治疗过程和随访期间从2到0有所改善。结论术前DOC和CRP水平升高可作为预后不良的预测因素。白细胞计数升高是术前状态不良的预测因子。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Neurochirurgica 医学-临床神经学

CiteScore

4.40

自引率

4.20%

发文量

342

审稿时长

1 months

期刊介绍： The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.