Predictors of Medical Complications in Aneurysmal Subarachnoid Hemorrhage during Vasospasm Stage

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  • NAKAMURA Homare
    Division of Neurosurgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital
  • KAWAGUCHI Kimiyuki
    Division of Neurosurgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital
  • UCHIDA Masashi
    Division of Neurosurgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital
  • ONODERA Hidetaka
    Division of Neurosurgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital
  • SAKAKIBARA Yohtaro
    Division of Neurosurgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital

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Other Title
  • くも膜下出血攣縮期における全身合併症の予測因子の検討

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To determine the predictors of medical complications in aneurysmal subarachnoid hemorrhage during the vasospasm stage, we reviewed the medical complications of 92 patients treated for ruptured cerebral aneurysm at our institutions between January 2010 and December 2014.<br>The 92 patients were divided into medical and non-medical complication groups. Their clinical characteristics were compared, including age, sex, World Federation of Neurological Surgeons (WFNS) grade, vasospasm, medical condition, creatinine (Cr) level, estimated glomerular filtration rate (eGFR), glycemia, cardiothoracic ratio at admission, albumin level, natrium level at onset of medical complication, Cr level 3 days after admission (first period), Cr level at onset of medical complication (second period), eGFR at 3 days after admission (first period), eGFR at onset of medical complication (second period), average intake volume for 3 days (first period), and onset of medical complication (days; second period) after admission by using the Mann-Whitney U test or Fisher test. Univariate and multiple logistic regression analyses were used to determine factors associated with risk of medical complication.<br>The overall rate of medical complication was 26.1% (24/92). The most common medical complication was pulmonary cardiac complication. The Mann-Whitney U test and univariate analyses showed WFNS grade and eGFR (second period) to be significantly higher in the medical complication group than in the non-medical complication group. The independent risk factors of medical complications that were identified in the multiple analyses were WFNS grade and eGFR (second period; odds ratio, 95% confidence interval: 4.9577, 1.6557-15.0264 and 6.6759, 2.2421-19.8780, respectively).<br>We identified WFNS grade and eGFR (second period) as independent risk factors. Under the wrong WFNS grade at admission, extensive care should be taken in the management of the disease. When eGFR is less than that at admission during the vasospasm stage, it may play a predictive role for medical complications.

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