Academic Journal
Clinical Outcome Prediction of Early Brain Injury in Aneurysmal Subarachnoid Hemorrhage: the SHELTER-Score
| Title: | Clinical Outcome Prediction of Early Brain Injury in Aneurysmal Subarachnoid Hemorrhage: the SHELTER-Score |
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| Authors: | Björn B. Hofmann, Daniel M. Donaldson, Milad Neyazi, Yousef Abusabha, Kerim Beseoglu, Daniel Hänggi, Jan F. Cornelius, Igor Fischer, Sajjad Muhammad |
| Contributors: | HUS Neurocenter, Clinicum, Research Programs Unit, Neurokirurgian yksikkö |
| Source: | Neurocrit Care |
| Publisher Information: | Springer Science and Business Media LLC, 2023. |
| Publication Year: | 2023 |
| Subject Terms: | Aneurysmal subarachnoid hemorrhage, Neuroprognostication, Modified Rankin Scale, Management of Vascular Malformations in the Brain, Logistic regression, Glasgow Outcome Scale, Brain Ischemia, Pathophysiology and Management of Cerebral Aneurysms, Ischemia, Vascular, Health Sciences, Humans, Subarachnoid hemorrhage, Glasgow Coma Scale, Anesthesia, Brain injury, Internal medicine, Outcome study, Retrospective Studies, Ischemic stroke, Aneurysmal Subarachnoid Hemorrhage, Neurointensive care, Brain Ischemia/etiology [MeSH], Intensive care, Early brain injury, Humans [MeSH], Treatment Outcome [MeSH], Retrospective Studies [MeSH], Subarachnoid Hemorrhage/complications [MeSH], Brain Injuries [MeSH], Prognosis [MeSH], Subarachnoid Hemorrhage/therapy [MeSH], Brain Ischemia/therapy [MeSH], Neurosciences, Management and Pathophysiology of Traumatic Brain Injury, Subarachnoid Hemorrhage, Prognosis, Vasospasm, 3. Good health, Treatment Outcome, Neurology, Brain Injuries, Medicine, Hemorrhage Predictors |
| Description: | Background Despite intensive research on preventing and treating vasospasm and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage (aSAH), mortality and morbidity rates remain high. Early brain injury (EBI) has emerged as possibly the major significant factor in aSAH pathophysiology, emphasizing the need to investigate EBI-associated clinical events for improved patient management and decision-making. This study aimed to identify early clinical and radiological events within 72 h after aSAH to develop a conclusive predictive EBI score for clinical practice. Methods This retrospective analysis included 561 consecutive patients with aSAH admitted to our neurovascular center between 01/2014 and 09/2022. Fourteen potential predictors occurring within the initial 72 h after hemorrhage were analyzed. The modified Rankin Scale (mRS) score at 6 months, discretized to three levels (0–2, favorable; 3–5, poor; 6, dead), was used as the outcome variable. Univariate ordinal regression ranked predictors by significance, and forward selection with McFadden’s pseudo-R2 determined the optimal set of predictors for multivariate proportional odds logistic regression. Collinear parameters were excluded, and fivefold cross-validation was used to avoid overfitting. Results The analysis resulted in the Subarachnoid Hemorrhage Associated Early Brain Injury Outcome Prediction score (SHELTER-score), comprising seven clinical and radiological events: age (0–4 points), World Federation of Neurosurgical Societies (0–2.5 points), cardiopulmonary resuscitation (CPR) (2 points), mydriasis (1–2 points), midline shift (0.5–1 points), early deterioration (1 point), and early ischemic lesion (2 points). McFadden’s pseudo-R2 = 0.339, area under the curve for death or disability 0.899 and 0.877 for death. A SHELTER-score below 5 indicated a favorable outcome (mRS 0–2), 5–6.5 predicted a poor outcome (mRS 3–5), and ≥ 7 correlated with death (mRS 6) at 6 months. Conclusions The novel SHELTER-score, incorporating seven clinical and radiological features of EBI, demonstrated strong predictive performance in determining clinical outcomes. This scoring system serves as a valuable tool for neurointensivists to identify patients with poor outcomes and guide treatment decisions, reflecting the great impact of EBI on the overall outcome of patients with aSAH. |
| Document Type: | Article Other literature type |
| File Description: | application/pdf; Text |
| Language: | English |
| ISSN: | 1556-0961 1541-6933 |
| DOI: | 10.1007/s12028-023-01879-y |
| DOI: | 10.60692/kd7sv-jns40 |
| DOI: | 10.60692/fcnab-1bj31 |
| Access URL: | https://pubmed.ncbi.nlm.nih.gov/38030877 http://hdl.handle.net/10138/574259 https://repository.publisso.de/resource/frl:6518017 |
| Rights: | CC BY |
| Accession Number: | edsair.doi.dedup.....2a2b0f7b286fc72d50e3677e407e39b6 |
| Database: | OpenAIRE |
| ISSN: | 15560961 15416933 |
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| DOI: | 10.1007/s12028-023-01879-y |