Cargando…

Edema Resolution and Clinical Assessment in Poor-Grade Subarachnoid Hemorrhage: Useful Indicators to Predict Delayed Cerebral Infarctions?

Background: The level of consciousness and cerebral edema are among the indicators that best define the intensity of early brain injury following aneurysmal subarachnoid hemorrhage (aSAH). Although these indicators are usually altered in patients with a poor neurological status, their usefulness for...

Descripción completa

Detalles Bibliográficos
Autores principales: Torné, Ramon, Hoyos, Jhon, Llull, Laura, Rodríguez-Hernández, Ana, Muñoz, Guido, Mellado-Artigas, Ricard, Santana, Daniel, Pedrosa, Leire, Di Somma, Alberto, San Roman, Luis, Amaro, Sergio, Enseñat, Joaquim
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7830766/
https://www.ncbi.nlm.nih.gov/pubmed/33477258
http://dx.doi.org/10.3390/jcm10020321
_version_ 1783641491675021312
author Torné, Ramon
Hoyos, Jhon
Llull, Laura
Rodríguez-Hernández, Ana
Muñoz, Guido
Mellado-Artigas, Ricard
Santana, Daniel
Pedrosa, Leire
Di Somma, Alberto
San Roman, Luis
Amaro, Sergio
Enseñat, Joaquim
author_facet Torné, Ramon
Hoyos, Jhon
Llull, Laura
Rodríguez-Hernández, Ana
Muñoz, Guido
Mellado-Artigas, Ricard
Santana, Daniel
Pedrosa, Leire
Di Somma, Alberto
San Roman, Luis
Amaro, Sergio
Enseñat, Joaquim
author_sort Torné, Ramon
collection PubMed
description Background: The level of consciousness and cerebral edema are among the indicators that best define the intensity of early brain injury following aneurysmal subarachnoid hemorrhage (aSAH). Although these indicators are usually altered in patients with a poor neurological status, their usefulness for selecting patients at risk of cerebral infarction (CI) is not well established. Furthermore, little is known about the evolution of these indicators during the first week of post-ictal events. Our study focused on describing the association of the longitudinal course of these predictors with CI occurrence in patients with severe aSAH. Methods: Out of 265 aSAH patients admitted consecutively to the same institution, 80 patients with initial poor neurological status (WFNS 4–5) were retrospectively identified. After excluding 25 patients with early mortality, a total of 47 patients who underwent early CT (<3 days) and late CT (<7 days) acquisitions were included in the study. Early cerebral edema and delayed cerebral edema were calculated using the SEBES score, and the level of consciousness was recorded daily during the first week using the Glasgow Coma Scale (GCS). Results: There was a significant improvement in the SEBES (Early-SEBES median (IQR) = 3 (2–4) versus Delayed-SEBES = 2 (1–3); p = 0.001) and in GCS scores (B = 0.32; 95% CI 0.15–0.49; p = 0.001) during the first week. When comparing the ROC curves of Delayed-SEBES vs Early-SEBES as predictors of CI, no significant differences were found (Early-SEBES Area Under the Curve: 0.65; Delayed-SEBES: 0.62; p = 0.17). Additionally, no differences were observed in the relationship between the improvement in the GCS across the first week and the occurrence of CI (p = 0.536). Conclusions: Edema and consciousness level improvement did not seem to be associated with the occurrence of CI in a surviving cohort of patients with severe aSAH. Our results suggest that intensive monitoring should not be reduced in patients with a poor neurological status regardless of an improvement in cerebral edema and level of consciousness during the first week after bleeding.
format Online
Article
Text
id pubmed-7830766
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-78307662021-01-26 Edema Resolution and Clinical Assessment in Poor-Grade Subarachnoid Hemorrhage: Useful Indicators to Predict Delayed Cerebral Infarctions? Torné, Ramon Hoyos, Jhon Llull, Laura Rodríguez-Hernández, Ana Muñoz, Guido Mellado-Artigas, Ricard Santana, Daniel Pedrosa, Leire Di Somma, Alberto San Roman, Luis Amaro, Sergio Enseñat, Joaquim J Clin Med Article Background: The level of consciousness and cerebral edema are among the indicators that best define the intensity of early brain injury following aneurysmal subarachnoid hemorrhage (aSAH). Although these indicators are usually altered in patients with a poor neurological status, their usefulness for selecting patients at risk of cerebral infarction (CI) is not well established. Furthermore, little is known about the evolution of these indicators during the first week of post-ictal events. Our study focused on describing the association of the longitudinal course of these predictors with CI occurrence in patients with severe aSAH. Methods: Out of 265 aSAH patients admitted consecutively to the same institution, 80 patients with initial poor neurological status (WFNS 4–5) were retrospectively identified. After excluding 25 patients with early mortality, a total of 47 patients who underwent early CT (<3 days) and late CT (<7 days) acquisitions were included in the study. Early cerebral edema and delayed cerebral edema were calculated using the SEBES score, and the level of consciousness was recorded daily during the first week using the Glasgow Coma Scale (GCS). Results: There was a significant improvement in the SEBES (Early-SEBES median (IQR) = 3 (2–4) versus Delayed-SEBES = 2 (1–3); p = 0.001) and in GCS scores (B = 0.32; 95% CI 0.15–0.49; p = 0.001) during the first week. When comparing the ROC curves of Delayed-SEBES vs Early-SEBES as predictors of CI, no significant differences were found (Early-SEBES Area Under the Curve: 0.65; Delayed-SEBES: 0.62; p = 0.17). Additionally, no differences were observed in the relationship between the improvement in the GCS across the first week and the occurrence of CI (p = 0.536). Conclusions: Edema and consciousness level improvement did not seem to be associated with the occurrence of CI in a surviving cohort of patients with severe aSAH. Our results suggest that intensive monitoring should not be reduced in patients with a poor neurological status regardless of an improvement in cerebral edema and level of consciousness during the first week after bleeding. MDPI 2021-01-17 /pmc/articles/PMC7830766/ /pubmed/33477258 http://dx.doi.org/10.3390/jcm10020321 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Torné, Ramon
Hoyos, Jhon
Llull, Laura
Rodríguez-Hernández, Ana
Muñoz, Guido
Mellado-Artigas, Ricard
Santana, Daniel
Pedrosa, Leire
Di Somma, Alberto
San Roman, Luis
Amaro, Sergio
Enseñat, Joaquim
Edema Resolution and Clinical Assessment in Poor-Grade Subarachnoid Hemorrhage: Useful Indicators to Predict Delayed Cerebral Infarctions?
title Edema Resolution and Clinical Assessment in Poor-Grade Subarachnoid Hemorrhage: Useful Indicators to Predict Delayed Cerebral Infarctions?
title_full Edema Resolution and Clinical Assessment in Poor-Grade Subarachnoid Hemorrhage: Useful Indicators to Predict Delayed Cerebral Infarctions?
title_fullStr Edema Resolution and Clinical Assessment in Poor-Grade Subarachnoid Hemorrhage: Useful Indicators to Predict Delayed Cerebral Infarctions?
title_full_unstemmed Edema Resolution and Clinical Assessment in Poor-Grade Subarachnoid Hemorrhage: Useful Indicators to Predict Delayed Cerebral Infarctions?
title_short Edema Resolution and Clinical Assessment in Poor-Grade Subarachnoid Hemorrhage: Useful Indicators to Predict Delayed Cerebral Infarctions?
title_sort edema resolution and clinical assessment in poor-grade subarachnoid hemorrhage: useful indicators to predict delayed cerebral infarctions?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7830766/
https://www.ncbi.nlm.nih.gov/pubmed/33477258
http://dx.doi.org/10.3390/jcm10020321
work_keys_str_mv AT torneramon edemaresolutionandclinicalassessmentinpoorgradesubarachnoidhemorrhageusefulindicatorstopredictdelayedcerebralinfarctions
AT hoyosjhon edemaresolutionandclinicalassessmentinpoorgradesubarachnoidhemorrhageusefulindicatorstopredictdelayedcerebralinfarctions
AT llulllaura edemaresolutionandclinicalassessmentinpoorgradesubarachnoidhemorrhageusefulindicatorstopredictdelayedcerebralinfarctions
AT rodriguezhernandezana edemaresolutionandclinicalassessmentinpoorgradesubarachnoidhemorrhageusefulindicatorstopredictdelayedcerebralinfarctions
AT munozguido edemaresolutionandclinicalassessmentinpoorgradesubarachnoidhemorrhageusefulindicatorstopredictdelayedcerebralinfarctions
AT melladoartigasricard edemaresolutionandclinicalassessmentinpoorgradesubarachnoidhemorrhageusefulindicatorstopredictdelayedcerebralinfarctions
AT santanadaniel edemaresolutionandclinicalassessmentinpoorgradesubarachnoidhemorrhageusefulindicatorstopredictdelayedcerebralinfarctions
AT pedrosaleire edemaresolutionandclinicalassessmentinpoorgradesubarachnoidhemorrhageusefulindicatorstopredictdelayedcerebralinfarctions
AT disommaalberto edemaresolutionandclinicalassessmentinpoorgradesubarachnoidhemorrhageusefulindicatorstopredictdelayedcerebralinfarctions
AT sanromanluis edemaresolutionandclinicalassessmentinpoorgradesubarachnoidhemorrhageusefulindicatorstopredictdelayedcerebralinfarctions
AT amarosergio edemaresolutionandclinicalassessmentinpoorgradesubarachnoidhemorrhageusefulindicatorstopredictdelayedcerebralinfarctions
AT ensenatjoaquim edemaresolutionandclinicalassessmentinpoorgradesubarachnoidhemorrhageusefulindicatorstopredictdelayedcerebralinfarctions