Blood Pressure Affects the Early CT Perfusion Imaging in Patients with aSAH Reflecting Early Disturbed Autoregulation

Hofmann, Björn B.; Donaldson, Daniel M.; Fischer, Igor; Karadağ, Cihat; Neyazi, Milad; Piedade, Guilherme Santos; Abusabha, Yousef; Muhammad, Sajjad; Rubbert, Christian; Hänggi, Daniel; Beseoglu, Kerim

doi:10.1007/s12028-023-01683-8

Cited by 11 publications

(7 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, ensuring adequate cerebral perfusion at a very early stage should be an important therapeutic goal in the EBI phase. Supporting this evaluation, the relationship between cerebral microvascular perfusion and blood pressure was recently clinically demonstrated in the EBI phase [34]. In contrast, in DCI, not only the reduction in perfusion itself, but also the heterogeneity of microvascular perfusion, are pathophysiologically relevant.…”

Section: Discussionmentioning

confidence: 66%

Evaluation of MTT Heterogeneity of Perfusion CT Imaging in the Early Brain Injury Phase: An Insight into aSAH Pathopysiology

et al. 2023

Self Cite

View full text Add to dashboard Cite

The concept of early brain injury (EBI) is based on the assumption of a global reduction in brain perfusion following aneurysmal subarachnoid hemorrhage (aSAH). However, the heterogeneity of computed tomography perfusion (CTP) imaging in EBI has not yet been investigated. In contrast, increased mean transit time (MTT) heterogeneity, a possible marker of microvascular perfusion heterogeneity, in the delayed cerebral ischemia (DCI) phase has recently been associated with a poor neurological outcome after aSAH. Therefore, in this study, we investigated whether the heterogeneity of early CTP imaging in the EBI phase is an independent predictor of the neurological outcome after aSAH. We retrospectively analyzed the heterogeneity of the MTT using the coefficient of variation (cvMTT) in early CTP scans (within 24 h after ictus) of 124 aSAH patients. Both linear and logistic regression were used to model the mRS outcome, which were treated as numerical and dichotomized values, respectively. Linear regression was used to investigate the linear dependency between the variables. No significant difference in cvMTT between the patients with and those without EVD could be observed (p = 0.69). We found no correlation between cvMTT in early CTP imaging and initial modified Fisher (p = 0.07) and WFNS grades (p = 0.23). The cvMTT in early perfusion imaging did not correlate significantly with the 6-month mRS for the entire study population (p = 0.15) or for any of the subgroups (without EVD: p = 0.21; with EVD: p = 0.3). In conclusion, microvascular perfusion heterogeneity, assessed by the heterogeneity of MTT in early CTP imaging, does not appear to be an independent predictor of the neurological outcome 6 months after aSAH.

show abstract

Section: Discussionmentioning

confidence: 66%

Evaluation of MTT Heterogeneity of Perfusion CT Imaging in the Early Brain Injury Phase: An Insight into aSAH Pathopysiology

et al. 2023

Self Cite

View full text Add to dashboard Cite

show abstract

“…The patients were managed according to in-house treatment guidelines, which have been described in previous publications. [18][19][20]…”

Section: Asah Managementmentioning

confidence: 99%

Revisiting the WFNS Score: Native Computed Tomography Imaging Improves Identification of Patients With “False Poor Grade” Aneurysmal Subarachnoid Hemorrhage

Hofmann,

Fischer,

Neyazi

et al. 2023

Neurosurgery

Self Cite

View full text Add to dashboard Cite

BACKGROUND AND OBJECTIVES: In patients suffering from aneurysmal subarachnoid hemorrhage (aSAH), the optimal time to determine the World Federation of Neurosurgical Societies (WFNS) score remains controversial because of possible confounding factors. Goals of this study were (1) to analyze the most sensitive timepoint to determine the WFNS score in patients with aSAH and (2) to evaluate the impact of initial native computed tomography (CT) imaging on reducing the mismatch of “false poor grade” patients. METHODS: We retrospectively analyzed daily WFNS scores from admission until day 7 in 535 aSAH patients and evaluated their predictive value for the modified Rankin Scale at discharge and 6 months postbleeding. Patients with an initial WFNS score of IV–V who showed improvement to a WFNS score of I–II within the first 7 days (even short-term) were defined as “false poor grade” patients. We tried to identify the “false poor grade” patients using parameters of the initial native CT imaging. RESULTS: Later determination of the WFNS score (day 1 vs 7; pseudo-R2 = 0.13 vs 0.21) increasingly improved its predictive value for neurological outcome at discharge (P < .001). We identified 39 “false poor grade” patients who had significantly better outcomes than “real poor grade” patients (N = 220) (modified Rankin Scale-discharge: 0-2, 56% vs 1%, P < .001; 3-5: 41% vs 56%, P = .12; 6: 3% vs 43%, P < .001). “False poor grade” patients differed significantly in initial CT parameters. A predictive model called “initial CT WFNS” (ICTWFNS) was developed, incorporating SEBES, Hijdra score, and LeRoux score (sensitivity = 0.95, specificity = 0.84, accuracy = 0.859, F1 = 0.673). ICTWFNS scores of ≤4.6 classified patients as “false poor grade.” CONCLUSION: The initial WFNS score may misclassify a subgroup of patients with aSAH as poor grade, which can be avoided by later determination of the WFNS score, at days 3–4 losing its usefulness. Alternatively, the initial WFNS score can be improved in its predictive value, especially in poor-grade patients, using criteria from the initial native CT imaging, such as the Hijdra, LeRoux, and Subarachnoid Hemorrhage Early Brain Edema score, combined in the ICTWFNS score with even higher predictive power.

show abstract

“…Growing knowledge and understanding from experimental aSAH research demonstrate that pathophysiological processes in the early phase after bleeding can set the stage for subsequent long-term complications and thus have a major impact on the patient’s outcome [ 5 , 9 , 20 ]. In short, the inflammatory cascade initiated during EBI leads to microvascular dysfunction, blood–brain barrier disruption, and formation of microthrombosis, which affects the clinical outcome by sustaining an inflammatory response [ 5 , 9 , 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcome Prediction of Early Brain Injury in Aneurysmal Subarachnoid Hemorrhage: the SHELTER-Score

Hofmann,

Donaldson,

Neyazi

et al. 2023

Neurocrit Care

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Blood Pressure Affects the Early CT Perfusion Imaging in Patients with aSAH Reflecting Early Disturbed Autoregulation

Cited by 11 publications

References 45 publications

Evaluation of MTT Heterogeneity of Perfusion CT Imaging in the Early Brain Injury Phase: An Insight into aSAH Pathopysiology

Evaluation of MTT Heterogeneity of Perfusion CT Imaging in the Early Brain Injury Phase: An Insight into aSAH Pathopysiology

Revisiting the WFNS Score: Native Computed Tomography Imaging Improves Identification of Patients With “False Poor Grade” Aneurysmal Subarachnoid Hemorrhage

Clinical Outcome Prediction of Early Brain Injury in Aneurysmal Subarachnoid Hemorrhage: the SHELTER-Score

Contact Info

Product

Resources

About