Effect of acute physiologic derangements on outcome after subarachnoid hemorrhage

被引:160
作者
Claassen, J
Vu, A
Kreiter, KT
Kowalski, RG
Du, EY
Ostapkovich, N
Fitzsimmons, BFM
Connolly, ES
Mayer, SA
机构
[1] Coll Phys & Surg, Div Crit Care Neurol, New York, NY USA
[2] Coll Phys & Surg, Dept Neurol, New York, NY USA
[3] Coll Phys & Surg, Dept Neurosurg, New York, NY USA
[4] Columbia Univ, Sch Publ Hlth, Dept Biostat, New York, NY 10027 USA
关键词
physiological derangement; subarachnoid hemorrhage; cerebral aneurysm; Acute Physiology and Chronic Health Evaluation; systemic inflammatory response syndrome; outcome;
D O I
10.1097/01.CCM.0000114830.48833.8A
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective. To determine the effect that acute physiologic derangements have on outcome after subarachnoid hemorrhage (SAH) and to design a composite score summarizing these abnormalities. Design: Prospective observational study. Setting: Neuroscience intensive care unit in a tertiary care academic center. Patients: Consecutive cohort of 413 patients with SAH admitted within 3 days of SAH onset with 3-month modified Rankin Scale scores. Interventions: None. Results. Among 20 physiologic variables assessed within 24 hirs of admission, four were independently associated with death or severe disability (modified Rankin Scale score, 4-6) at 3 months in a multivariate analysis: arterio-alveolar gradient of >125 mm Hg (odds ratio [OR], 4.5; 95% confidence interval [CI], 2.7-7.6), serum bicarbonate of <20 mmol/L (OR, 2.9; 95% CI, 1.6-5.6), serum glucose of >180 mg/dL (OR, 2.8; 95% CI, 1.6-4.8), and mean arterial pressure of <70 or >130 mm Hg (OR, 1.7; 95% CI, 1.0-2.9). Based on their proportional contribution to outcome, we constructed the SAH Physiologic Derangement Score (SAH-PDS; range, 0-8) by assigning the following weights for abnormal findings: arterio-alveolar gradient, 3 points; bicarbonate, 2 points; glucose, 2 points; and mean arterial pressure, 1 point. After controlling for known predictors of death or severe disability (age, admission neurologic status, loss of consciousness, aneurysm size, intraventricular hemorrhage, and re-bleeding), the SAH Physiologic Derangement Score was independently associated with poor outcome (OR, 1.3 for each point increase; 95% CI, 1.1-1.6). By contrast, the systemic inflammatory response syndrome score and the Acute Physiology and Chronic Health Evaluation II physiologic subscore did not add predictive value to the model. Conclusion. Acute interventions specifically targeting hypoxemia, metabolic acidosis, hyperglycemia, and cardiovascular instability may improve the outcome of SAH patients. The SAH Physiologic Derangement Score may prove useful for rapidly quantifying the severity of important physiologic derangements in acute SAH.
引用
收藏
页码:832 / 838
页数:7
相关论文
共 32 条
[1]   Initial hyperglycemia as an indicator of severity of the ictus in poor-grade patients with spontaneous subarachnoid hemorrhage [J].
Alberti, O ;
Becker, R ;
Benes, L ;
Wallenfang, T ;
Bertalanffy, H .
CLINICAL NEUROLOGY AND NEUROSURGERY, 2000, 102 (02) :78-83
[2]  
ARTIOLA I, 1981, J NEUROSURG, V54, P26
[3]   A NOVEL SCORE FOR PREDICTING THE MORTALITY OF SEPTIC SHOCK PATIENTS [J].
BAUMGARTNER, JD ;
BULA, C ;
VANEY, C ;
WU, MM ;
EGGIMANN, P ;
PERRET, C .
CRITICAL CARE MEDICINE, 1992, 20 (07) :953-960
[4]  
BLECK TP, 1993, NEUROLOGY, V43, pA325
[5]   AMERICAN-COLLEGE OF CHEST PHYSICIANS SOCIETY OF CRITICAL CARE MEDICINE CONSENSUS CONFERENCE - DEFINITIONS FOR SEPSIS AND ORGAN FAILURE AND GUIDELINES FOR THE USE OF INNOVATIVE THERAPIES IN SEPSIS [J].
BONE, RC ;
BALK, RA ;
CERRA, FB ;
DELLINGER, RP ;
FEIN, AM ;
KNAUS, WA ;
SCHEIN, RMH ;
SIBBALD, WJ ;
ABRAMS, JH ;
BERNARD, GR ;
BIONDI, JW ;
CALVIN, JE ;
DEMLING, R ;
FAHEY, PJ ;
FISHER, CJ ;
FRANKLIN, C ;
GORELICK, KJ ;
KELLEY, MA ;
MAKI, DG ;
MARSHALL, JC ;
MERRILL, WW ;
PRIBBLE, JP ;
RACKOW, EC ;
RODELL, TC ;
SHEAGREN, JN ;
SILVER, M ;
SPRUNG, CL ;
STRAUBE, RC ;
TOBIN, MJ ;
TRENHOLME, GM ;
WAGNER, DP ;
WEBB, CD ;
WHERRY, JC ;
WIEDEMANN, HP ;
WORTEL, CH .
CRITICAL CARE MEDICINE, 1992, 20 (06) :864-874
[6]   INITIAL AND RECURRENT BLEEDING ARE THE MAJOR CAUSES OF DEATH FOLLOWING SUBARACHNOID HEMORRHAGE [J].
BRODERICK, JP ;
BROTT, TG ;
DULDNER, JE ;
TOMSICK, T ;
LEACH, A .
STROKE, 1994, 25 (07) :1342-1347
[7]   THE ROLE OF SECONDARY BRAIN INJURY IN DETERMINING OUTCOME FROM SEVERE HEAD-INJURY [J].
CHESNUT, RM ;
MARSHALL, LF ;
KLAUBER, MR ;
BLUNT, BA ;
BALDWIN, N ;
EISENBERG, HM ;
JANE, JA ;
MARMAROU, A ;
FOULKES, MA .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1993, 34 (02) :216-222
[8]   Predictors and clinical impact of epilepsy after subarachnoid hemorrhage [J].
Claassen, J ;
Peery, S ;
Kreiter, KT ;
Hirsch, LJ ;
Du, EY ;
Connolly, ES ;
Mayer, SA .
NEUROLOGY, 2003, 60 (02) :208-214
[9]   Global cerebral edema after subarachnoid hemorrhage - Frequency, predictors, and impact on outcome [J].
Claassen, J ;
Carhuapoma, JR ;
Kreiter, KT ;
Du, EY ;
Connolly, ES ;
Mayer, SA .
STROKE, 2002, 33 (05) :1225-1232
[10]   Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage - The Fisher scale revisited [J].
Claassen, J ;
Bernardini, GL ;
Kreiter, K ;
Bates, J ;
Du, YLE ;
Copeland, D ;
Connolly, ES ;
Mayer, SA .
STROKE, 2001, 32 (09) :2012-2020