Article
Predictors of functional outcome in patients with symptomatic chronic subdural hematoma: preliminary results of a prospective study
Prädiktoren des funktionellen Outcomes bei Patienten mit symptomatischen chronisch Subduralhämatomen: vorläufige Ergebnisse einer prospektiven Studie
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Authors
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Mehdi Chihi
- Department of Neurosurgery, University Hospital Essen, Germany
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Homajoun Maslehaty
- Department of Orthopedics and trauma surgery, St. Vinzenz Hospital Dinslaken, Germany
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Bernd-Otto Hütter
- Department of Neurosurgery, University Hospital Essen, Germany
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Ramazan Jabbarli
- Department of Neurosurgery, University Hospital Essen, Germany
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Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, Germany
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Karsten H. Wrede
- Department of Neurosurgery, University Hospital Essen, Germany
| Published: | June 26, 2020 |
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Outline
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Background: Brain natriuretic peptide (BNP) is a reliable biomarker for congestive heart failure in the acute phase. In our ongoing prospective study, we demonstrated an increase of BNP serum levels in patients with symptomatic chronic subdural hematoma (cSDH). The purpose of the current study was to investigate, whether BNP can predict the long-term functional outcome of patients with cSDH.
Methods: In this study, we included patients with cSDH, which underwent surgery at our department between November 2016 and October 2019. We excluded patients with recurrent bleedings, traumatic brain injury, cSDH associated with other intracranial pathologies and with a history of congestive heart failure, renal or endocrine disease from analysis. We measured BNP serum levels pre- and postoperatively and at discharge. BNP values were analysed in view of the patients’ medical history and clinical condition. The degree of disability of the patients was assessed using the modified Rankin scale (mRS) at admission, discharge and at follow-up (3-6 months) through a standardized telephone interview after surgery (n=86).
Results: In total, 94 patients were included in the study and underwent surgery (median age 76 years, male/female 3.5:1). 86 patients (91.5%) were available for the follow-up phone interview. At admission, 50 patients (53.2%) had a mRS score >3. A poor outcome (mRS >3) was observed at discharge in 32 patients (34%; p<0.05) and in 13 patients at follow-up (13.8%; p<0.05). The preoperative BNP serum level (BNP-1) was elevated (>35 pg/ml) in 68.1% of the patients (median BNP-1=104.8 vs. 21.1 pg/ml; p<0.001). The univariate analysis showed a statistically significant association between mRS at discharge and patient’s age (p=0.001), BNP-1 (p=0.009), mRS (p=0.0005) and Glasgow Coma Scale (p=0.01) scores at admission. The mRS score at follow-up showed a significant relationship with patient’s age (p=0.005) and BNP-1 (p=0.002). In the multivariate analysis, a poor functional outcome at discharge could be predicted by an advanced age and a preoperative mRS score >3, whereas, at FU by increased BNP-1.
Conclusion: The results of our study provide an important insight into prognostic factors after surgery of symptomatic cSDH. Although advanced age and poor preoperative functional status predicted poor functional outcome at discharge, they could not predict outcome at follow-up. In contrast, increased BNP-1 was an independent predictor of poor functional outcome at follow-up.
