Artikel
Predictive value of Fisher, Graeb and Le Roux score for case fatality risk and chronic hydrocephalus in subarachnoid hemorrhage
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Autoren
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Patrick Czorlich
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
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Franz Ricklefs
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
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Matthias Reitz
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
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Jan Regelsberger
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
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Manfred Westphal
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
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Nils Ole Schmidt
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: Reliable prognostic tools to estimate the case fatality rate (CFR) and the development of chronic hydrocephalus (CHC) in aneurysmal subarachnoid hemorrhage (SAH) are not well-defined. This study aimed to investigate the practicability and reliability of Fisher, Graeb and Le Roux scores for SAH patient prognosis.
Method: 206 patients with aneurysmal SAH were retrospectively analyzed in prediction of CFR and CHC. Clinical data was evaluated and grading was performed using Fisher, Graeb and Le Roux scores. Furthermore other possible variables as age, gender, localization and treatment of aneurysm, development of DCI and presence of intracerebral hematoma were taken into analyses. Univariate and multivariate analyses were performed to identify relevant predictive parameters.
Results: CFR was 17.0% (35/206 patients) and was associated with higher age, higher Hunt & Hess (H&H) grade, lower Glasgow coma scale (GCS) at admission, as well as a higher Fisher, Graeb and Le Roux score (p < 0.001). 19.9% ((34/171) developed CHC requiring permanent cerebrospinal fluid diversion. The same parameters except age were associated with a higher rate of cerebrospinal fluid diversion in surviving patients, low initial GCS (p = 0.003), high H&H (p < 0.001), high Fisher (p = 0.047) as well as presence of acute hydrocephalus (p < 0.001), intracerebral hematoma (p = 0.003) as well as Graeb and Le Roux scores (p < 0.001). In multivariate analyses Graeb score (odds ratio (OR) 1.183 [1.027, 1.363], p = 0.020), Le Roux score (OR 1.120 [1.013, 1.239, p = 0.027) and H&H (OR 2.745 [1.511, 4.987], p = 0.001) remained independent prognostic factors for VPS. Correlation of Graeb and Le Roux score using Pearson's product-moment correlation was excellent (r = 0.9799, p < 0.001).
Conclusions: Intraventricular hemorrhage is an independent prognostic factor for the development of chronic hydrocephalus requiring ventricular-peritoneal shunting. Therefore Graeb and Le Roux scores are reliable, quick and easy scores to measure intraventricular hemorrhage, predict the occurrence of CHC and have the potential to help guide physicians in the management of SAH patients. Beyond that Graeb and Le Roux score have at least an impact in CFR of SAH patients.
