Grading Scores for Identifying Patients at Risk of Delayed Cerebral Ischemia and Neurological Outcome in Spontaneous Subarachnoid Hemorrhage: A Comparison of Receiver Operator Curve Analysis.
Alessia Degrassi, Caren Conticello, Hassane Njimi, Giacomo Coppalini, Fernando Oliveira, Alberto Diosdado, Marco Anderloni, Lise Jodaitis, Sophie Schuind, Fabio Silvio Taccone, Elisa Gouvêa Bogossian
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引用次数: 0
Abstract
Background: Numerous grading scales were proposed for subarachnoid hemorrhage (SAH) to assess the likelihood of unfavorable neurological outcomes (UO) and the risk of delayed cerebral ischemia (DCI). We aimed to validate the Hemorrhage, Age, Treatment, Clinical Status, and Hydrocephalus (HATCH) score and the VASOGRADE, a simple grading scale for prediction of DCI after aneurysmal SAH.
Methods: This was a retrospective single-center study of patients with nontraumatic SAH (January 2016 to December 2021) admitted to the intensive care unit. We performed a receiver operating characteristic (ROC) curve analysis to assess the discriminative ability of the HATCH and the VASOGRADE to identify patients who had UO at 3 months (defined as Glasgow Outcome Scale score of 1-3), hospital mortality, and DCI and compared their performance with the World Federation of Neurosurgical Surgeons, the modified Fisher, the Sequential Organ Failure Assessment, and the Acute Physiology and Chronic Health Evaluation II scales. We performed a multivariate logistic regression analysis to assess the association between HATCH and UO at 3 months and between VASOGRADE and DCI.
Results: We included 262 consecutive patients with nontraumatic SAH. DCI was observed in 82 patients (31.3%), whereas 78 patients (29.8%) died during hospital stay and 133 patients (51%) had UO at 3 months. HATCH was independently associated with UO (odds ratio 1.61, 95% confidence interval [CI] 1.36-1.90) and had an area under the ROC curve (AUROC) of 0.83 (95% CI 0.77-0.88), comparable to the Acute Physiology and Chronic Health Evaluation II (AUROC 0.84, 95% CI 0.79-0.89) and Sequential Organ Failure Assessment (AUROC 0.83, 95% CI 0.77-0.88).
Conclusions: Hemorrhage, Age, Treatment, Clinical Status, and Hydrocephalus and VASOGARDE scores had a good performance to predict UO or in-hospital mortality and DCI, respectively; however, their performance did not outperform nonspecific routinely used scores.
背景:为了评估蛛网膜下腔出血(SAH)不良神经预后(UO)的可能性和延迟性脑缺血(DCI)的风险,提出了许多分级量表。我们的目的是验证出血、年龄、治疗、临床状态和脑积水(HATCH)评分和VASOGRADE(一种预测动脉瘤性SAH后DCI的简单分级量表)。方法:这是一项回顾性单中心研究,研究对象是2016年1月至2021年12月入住重症监护室的非创伤性SAH患者。我们进行了受试者工作特征(ROC)曲线分析,以评估HATCH和VASOGRADE的鉴别能力,以识别3个月时患有UO(定义为格拉斯哥结局量表得分为1-3)、住院死亡率和DCI的患者,并将他们的表现与世界神经外科医师联合会、改良的Fisher、顺序器官衰竭评估和急性生理和慢性健康评估II量表进行比较。我们进行了多变量logistic回归分析,以评估3个月时HATCH和UO之间以及VASOGRADE和DCI之间的关系。结果:我们纳入262例连续的非创伤性SAH患者。82例患者(31.3%)出现DCI,而78例患者(29.8%)在住院期间死亡,133例患者(51%)在3个月时出现UO。HATCH与UO独立相关(优势比1.61,95%可信区间[CI] 1.36-1.90), ROC曲线下面积(AUROC)为0.83 (95% CI 0.77-0.88),与急性生理和慢性健康评估II (AUROC 0.84, 95% CI 0.79-0.89)和序贯器官衰竭评估(AUROC 0.83, 95% CI 0.77-0.88)相当。结论:出血、年龄、治疗、临床状况、脑积水和VASOGARDE评分分别可较好地预测UO或院内死亡率和DCI;然而,他们的表现并没有超过非特定的常规使用分数。
期刊介绍:
Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.