Dynamic correlation between brain edema scores and blood–brain barrier permeability predicts the outcome of aneurysmal subarachnoid hemorrhage

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-07-31 DOI:10.1016/j.clineuro.2025.109086

Chao Zhang , Wenjuan Tang , Pengzhan Yin , Xintong Zhao , Xinggen Fang , Yunfeng Zhou

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Abstract

Objective

Cerebral edema and disruption of the blood-brain barrier (BBB) are common consequences of aneurysmal subarachnoid hemorrhage (aSAH) and can be visualized by CT. This study investigated the dynamic correlation between the Subarachnoid Hemorrhage Early Brain Edema Score (SEBES) and BBB permeability (BBBP) between admission and during the delayed cerebral ischemia (DCI) time window (DCITW) in patients with aSAH.

Methods

We investigated 129 patients with aSAH who underwent CT perfusion imaging on admission and during DCITW. The correlations between SEBES and BBBP (measured by K^trans) and between their dynamic changes (expressed as ΔSEBES and ΔK^trans) were evaluated using Spearman correlation coefficients. Longitudinal changes in both parameters were analyzed. Multivariate logistic regression was employed to identify independent risk factors for DCI and poor outcomes.

Results

A moderate correlation was observed between SEBES and K^trans both on admission (ρ=0.64, P < 0.001) and during DCITW (ρ=0.65, P < 0.001). A moderately strong correlation (ρ=0.70, P < 0.001) was found between ΔSEBES and ΔK^trans. Both the SEBES (2 [1,2] versus 1 [0,2], P < 0.001) and K^trans (0.47 ± 0.14 versus 0.41 ± 0.14, P = 0.001) decreased significantly between admission and DCITW. In the adjusted models, the SEBES on admission and during DCITW were independent predictors of DCI (OR 1.92, 95 % CI 1.08–3.43; P = 0.028) and poor outcomes (OR 3.87, 95 % CI 2.14–6.99; P < 0.001).

Conclusions

Following aSAH, the severity of cerebral edema is significantly correlated with the degree of BBB disruption. Their temporal evolution patterns between admission and DCITW are interrelated. This study provides mechanistic insights into their combined role in predicting clinical outcomes.

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脑水肿评分与血脑屏障通透性的动态相关性预测动脉瘤性蛛网膜下腔出血的预后

目的脑水肿和血脑屏障破坏是动脉瘤性蛛网膜下腔出血（aSAH）的常见后果，可通过CT表现出来。本研究探讨了aSAH患者入院与延迟性脑缺血（DCI）时间窗（DCITW）期间蛛网膜下腔出血早期脑水肿评分（SEBES）与血脑屏障通透性（BBBP）的动态相关性。方法对129例aSAH患者在入院及DCITW期间行CT灌注显像。采用Spearman相关系数评价SEBES与BBBP（以Ktrans测量）及其动态变化（以ΔSEBES和ΔKtrans表示）之间的相关性。分析了这两个参数的纵向变化。采用多变量logistic回归来确定DCI和不良结局的独立危险因素。结果SEBES与Ktrans在入院时（ρ=0.64, P <； 0.001）和DCITW期间（ρ=0.65, P <； 0.001）均呈中等相关性。ΔSEBES和ΔKtrans之间存在中等强度的相关性（ρ=0.70, P <； 0.001）。SEBES（2[1,2]对1 [0,2],P <； 0.001）和Ktrans（0.47 ± 0.14对0.41 ± 0.14,P = 0.001）在入院和DCITW期间均显著下降。在调整后的模型中，入院时和DCITW期间的SEBES是DCI的独立预测因子(OR 1.92, 95 % CI 1.08-3.43；P = 0.028)和不良结局(OR 3.87, 95 % CI 2.14-6.99；P & lt; 0.001)。结论aSAH后脑水肿严重程度与血脑屏障破坏程度显著相关。它们在入场和DCITW之间的时间演变模式是相互关联的。这项研究为它们在预测临床结果中的联合作用提供了机制上的见解。

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

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.