PDF(Pubmed)
Abstract：
UNASSIGNED: Aneurysmal subarachnoid hemorrhage (aSAH) necessitating mechanical ventilation (MV) presents a serious challenge for intensivists. Laboratory blood tests reflect individual physiological and biochemical states, and provide a useful tool for identifying patients with critical condition and stratifying risk levels of death. This study aimed to determine the prognostic role of initial routine laboratory blood tests in these patients.
UNASSIGNED: This retrospective cohort study included 190 aSAH patients requiring MV in the neurosurgical intensive care unit from December 2019 to March 2022. Follow-up evaluation was performed in May 2022 via routine outpatient appointment or telephone interview. The primary outcomes were death occurring within 7 days after discharge (short-term mortality) or reported at time of follow-up (long-term mortality). Clinico-demographic and radiological characteristics, initial routine laboratory blood tests (e.g., metabolic panels and arterial blood gas analysis), and treatment were analyzed and compared in relation to mortality. Multivariable logistic and Cox regression analyses, with adjustment of other clinical predictors, were performed to determine independent laboratory test predictors for short- and long-term mortality, respectively.
UNASSIGNED: The patients had a median age of 62 years, with a median World Federation of Neurosurgical Societies grade (WFNS) score of 5 and a median modified Fisher grade (mFisher) score of 4. The short- and long-term mortality of this cohort were 60.5% and 65.3%, respectively. Compared with survivors, non-survivors had more severe disease upon admission based on neurological status and imaging features and a shorter disease course, and were more likely to receive conservative treatment. Initial ionized calcium was found to be independently associate with both short-term [adjusted odds ratio (OR): 0.92; 95% confidence interval (CI): 0.86 to 0.99; P=0.020] and long-term mortality [adjusted hazard ratio (HR): 0.95; 95% CI: 0.92 to 0.99; P=0.010], after adjusting for potential confounders. Moreover, the admission glucose level was found to be associated only with short-term mortality (adjusted OR: 1.19; 95% CI: 1.06 to 1.34; P=0.004).
UNASSIGNED: Laboratory screening may provide a useful tool for the management of aSAH patients requiring MV in stratifying risk levels for mortality and for better clinical decision-making. Further study is needed to validate the effects of calcium supplementation and glucose-lowering therapy on the outcomes in this disease.
UNASSIGNED: This retrospective cohort study included 190 aSAH patients requiring MV in the neurosurgical intensive care unit from December 2019 to March 2022. Follow-up evaluation was performed in May 2022 via routine outpatient appointment or telephone interview. The primary outcomes were death occurring within 7 days after discharge (short-term mortality) or reported at time of follow-up (long-term mortality). Clinico-demographic and radiological characteristics, initial routine laboratory blood tests (e.g., metabolic panels and arterial blood gas analysis), and treatment were analyzed and compared in relation to mortality. Multivariable logistic and Cox regression analyses, with adjustment of other clinical predictors, were performed to determine independent laboratory test predictors for short- and long-term mortality, respectively.
UNASSIGNED: The patients had a median age of 62 years, with a median World Federation of Neurosurgical Societies grade (WFNS) score of 5 and a median modified Fisher grade (mFisher) score of 4. The short- and long-term mortality of this cohort were 60.5% and 65.3%, respectively. Compared with survivors, non-survivors had more severe disease upon admission based on neurological status and imaging features and a shorter disease course, and were more likely to receive conservative treatment. Initial ionized calcium was found to be independently associate with both short-term [adjusted odds ratio (OR): 0.92; 95% confidence interval (CI): 0.86 to 0.99; P=0.020] and long-term mortality [adjusted hazard ratio (HR): 0.95; 95% CI: 0.92 to 0.99; P=0.010], after adjusting for potential confounders. Moreover, the admission glucose level was found to be associated only with short-term mortality (adjusted OR: 1.19; 95% CI: 1.06 to 1.34; P=0.004).
UNASSIGNED: Laboratory screening may provide a useful tool for the management of aSAH patients requiring MV in stratifying risk levels for mortality and for better clinical decision-making. Further study is needed to validate the effects of calcium supplementation and glucose-lowering therapy on the outcomes in this disease.
摘要：
■需要机械通气（MV）的动脉瘤性蛛网膜下腔出血（aSAH）对重症医师提出了严峻的挑战。实验室血液检查反映了个体的生理和生化状态，并提供了一个有用的工具来识别患者的危重情况和分层的死亡风险水平。这项研究旨在确定这些患者的初始常规实验室血液检查的预后作用。
■这项回顾性队列研究包括2019年12月至2022年3月在神经外科重症监护病房需要MV的190例aSAH患者。2022年5月通过常规门诊预约或电话访谈进行随访评估。主要结局是出院后7天内发生的死亡（短期死亡率）或随访时报告的死亡（长期死亡率）。临床人口统计学和放射学特征，初始常规实验室血液检查(例如，代谢面板和动脉血气分析)，分析和比较治疗与死亡率的关系。多变量逻辑和Cox回归分析，随着其他临床预测因子的调整，进行以确定短期和长期死亡率的独立实验室测试预测因子，分别。
■患者的中位年龄为62岁，世界神经外科学会联合会（WFNS）的中位数评分为5分，而改良Fisher（mFisher）的中位数评分为4分。该队列的短期和长期死亡率分别为60.5%和65.3%，分别。与幸存者相比，根据神经状态和影像学特征，非幸存者入院时疾病更严重，病程更短，更有可能接受保守治疗。发现初始离子钙与短期[调整后的比值比（OR）：0.92;95％置信区间（CI）：0.86至0.99;P=0.020]和长期死亡率[调整后的风险比（HR）：0.95;95％CI：0.92至0.99;P=0.010]，在调整了潜在的混杂因素后。此外，入院血糖水平仅与短期死亡率相关(校正后OR:1.19;95%CI:1.06~1.34;P=0.004).
实验室筛查可能为需要MV的aSAH患者的管理提供有用的工具，以分层死亡风险水平和更好的临床决策。需要进一步的研究来验证补钙和降糖治疗对这种疾病预后的影响。
■这项回顾性队列研究包括2019年12月至2022年3月在神经外科重症监护病房需要MV的190例aSAH患者。2022年5月通过常规门诊预约或电话访谈进行随访评估。主要结局是出院后7天内发生的死亡（短期死亡率）或随访时报告的死亡（长期死亡率）。临床人口统计学和放射学特征，初始常规实验室血液检查(例如，代谢面板和动脉血气分析)，分析和比较治疗与死亡率的关系。多变量逻辑和Cox回归分析，随着其他临床预测因子的调整，进行以确定短期和长期死亡率的独立实验室测试预测因子，分别。
■患者的中位年龄为62岁，世界神经外科学会联合会（WFNS）的中位数评分为5分，而改良Fisher（mFisher）的中位数评分为4分。该队列的短期和长期死亡率分别为60.5%和65.3%，分别。与幸存者相比，根据神经状态和影像学特征，非幸存者入院时疾病更严重，病程更短，更有可能接受保守治疗。发现初始离子钙与短期[调整后的比值比（OR）：0.92;95％置信区间（CI）：0.86至0.99;P=0.020]和长期死亡率[调整后的风险比（HR）：0.95;95％CI：0.92至0.99;P=0.010]，在调整了潜在的混杂因素后。此外，入院血糖水平仅与短期死亡率相关(校正后OR:1.19;95%CI:1.06~1.34;P=0.004).
实验室筛查可能为需要MV的aSAH患者的管理提供有用的工具，以分层死亡风险水平和更好的临床决策。需要进一步的研究来验证补钙和降糖治疗对这种疾病预后的影响。
