基于CT的VASOGRADE评分对老年蛛网膜下腔出血患者迟发性脑缺血发生的预测价值^*

The predictive value of CT-assessed VASOGRADE score for delayed cerebral ischemia in elderly patients with subarachnoid hemorrhage

摘要

目的 探讨CT评估的 VASOGRADE 评分对老年蛛网膜下腔出血患者迟发性脑缺血的预测价值。方法 回顾性分析2020年3月—2024年5月首都医科大学附属北京天坛医院收治的240例老年蛛网膜下腔出血患者的临床资料,根据住院期间是否发生迟发性脑缺血,最终分为迟发性脑缺血组(68例)与非迟发性脑缺血组(172例)。收集患者基线资料、入院48 h内的CT检查指标(Fisher分级、VASOGRADE评分、颅内动脉瘤最大径)及实验室指标[血清同型半胱氨酸(Hcy)、C反应蛋白(CRP)、凝血酶原时间(PT)]。采用单因素分析、多因素logistic回归分析筛选发生迟发性脑缺血的危险因素。通过ROC曲线评估VASOGRADE评分对迟发性脑缺血的预测效能,并根据最佳截断值分组比较结局的差异。结果 单因素分析显示,两组Fisher分级、VASOGRADE评分、颅内动脉瘤最大径及CRP水平比较,差异均有统计学意义(P<0.05);多因素logistic回归分析显示,VASOGRADE评分是老年蛛网膜下腔出血患者发生迟发性脑缺血的独立危险因素(OR=2.284,95%CI:1.499～3.481,P<0.05);ROC曲线分析显示,VASOGRADE评分预测迟发性脑缺血的AUC为0.840(95%CI:0.762～0.919),最佳截断值为6分;以该截断值分为高危组(≥6分,81例)与低危组(<6分,159例),高危组改良Rankin量表评分、迟发性脑缺血相关梗死发生率、肺部感染发生率均高于低危组(P<0.05)。结论 VASOGRADE评分可有效预测老年蛛网膜下腔出血患者迟发性脑缺血发生的风险,临床可基于该评分制定个体化干预策略,改善患者预后。

Abstract

Objective To investigate the predictive value of CT-evaluated VASOGRADE score for delayed cerebral ischemia in elderly patients with subarachnoid hemorrhage. Methods A total of 240 elderly patients with subarachnoid hemorrhage admitted to Beijing Tiantan Hospital, Capital Medical University from March 2020 to May 2024 were retrospectively included. According to whether delayed cerebral ischemia occurred during hospitalization, they were divided into a delayed cerebral ischemia group (68 cases) and a non-delayed cerebral ischemia group ( 172 cases ). Baseline data, CT examination indexes(VASOGRADE score, maximum diameter of intracranial aneurysm,Fisher grade) and laboratory indexes [ serum homocysteine ( Hcy ), C-reactive protein ( CRP ), prothrombin time ( PT ) ] within 48 h after admission were collected. Univariate analysis and multivariate logistic regression analysis were used to screen for the risk factors of delayed cerebral ischemia. The predictive efficacy of VASOGRADE score for delayed cerebral ischemia was evaluated by ROC curve, and the secondary outcome differences were compared according to the optimal cutoff value. Results Univariate analysis showed that there were significant differences in Fisher grade, VASOGRADE score, maximum diameter of intracranial aneurysm and CRP level between the two groups( P < 0.05 ). Multivariate logistic regression analysis confirmed that the VASOGRADE score was an independent risk factor for delayed cerebral ischemia in elderly subarachnoid hemorrhage patients(OR=2.284,95%CI : 1.499-3.481, P<0.05) . ROC curve analysis showed that the AUC of VASOGRADE score in predicting delayed cerebral ischemia was 0.840(95%CI: 0.762-0.919), and the optimal cut-off value was 6. According to the cutoff value, they were divided into high-risk group (≥ 6 scores, n= 81 ) and low-risk group ( < 6 scores, n= 159 ). The modified Rankin scale score, incidence of delayed cerebral ischemia-related infarction and incidence of pulmonary infection in high-risk group were higher than those in low-risk group (P<0.05). Conclusion The VASOGRADE score can effectively predict the risk of delayed cerebral ischemia in elderly patients with subarachnoid hemorrhage.Individualized intervention strategies can be developed based on this score to improve the prognosis of patients.

关键词

蛛网膜下腔出血 / 迟发性脑缺血 / VASOGRADE评分 / 预测价值

Key words

Subarachnoid hemorrhage / Delayed cerebral ischemia / VASOGRADE score / Predictive value

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基金资助

^*首都卫生发展科研专项项目(首发 2024-1-1192)