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Poor-grade aneurysmal subarachnoid hemorrhage: relationship of cerebral metabolism to outcome.
J Neurosurg. 2004 Mar; 100(3):400-6.JN

Abstract

OBJECT

The majority of patients with poor-grade subarachnoid hemorrhage (SAH), that is, World Federation of Neurosurgical Societies (WFNS) Grades IV and V, have high morbidity and mortality rates. The objective of this study was to investigate cerebral metabolism in patients with low- compared with high-grade SAH by using bedside microdialysis and to evaluate whether microdialysis parameters are of prognostic value for outcome in SAH.

METHODS

A prospective investigation was conducted in 149 patients with SAH (mean age 50.9 +/- 12.9 years); these patients were studied for 162 +/- 84 hours (mean +/- standard deviation). Lesions were classified as low-grade SAH (WFNS Grades I-III, 89 patients) and high-grade SAH (WFNS Grade IV or V, 60 patients). After approval by the local ethics committee and consent from the patient or next of kin, a microdialysis catheter was inserted into the vascular territory of the aneurysm after clip placement. The microdialysates were analyzed hourly for extracellular glucose, lactate, lactate/pyruvate (L/P) ratio, glutamate, and glycerol. The 6- and 12-month outcomes according to the Glasgow Outcome Scale and functional disability according to the modified Rankin Scale were assessed. In patients with high-grade SAH, cerebral metabolism was severely deranged compared with those who suffered low-grade SAH, with high levels (p < 0.05) of lactate, a high L/P ratio, high levels of glycerol, and, although not significant, of glutamate. Univariate analysis revealed a relationship among hyperglycemia on admission, Fisher grade, and 12-month outcome (p < 0.005). In a multivariate regression analysis performed in 131 patients, the authors identified four independent predictors of poor outcome at 12 months, in the following order of significance: WFNS grade, patient age, L/P ratio, and glutamate (p < 0.03).

CONCLUSIONS

Microdialysis parameters reflected the severity of SAH. The L/P ratio was the best metabolic independent prognostic marker of 12-month outcome. A better understanding of the causes of deranged cerebral metabolism may allow the discovery of therapeutic options to improve the prognosis, especially in patients with high-grade SAH, in the future.

Authors+Show Affiliations

Department of Neurosurgery and Institute of Medical Biometry, Charité Virchow Medical Center, Humboldt University of Berlin, Germany. asita.sarrafzadeh@charite.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15035274

Citation

Sarrafzadeh, Asita, et al. "Poor-grade Aneurysmal Subarachnoid Hemorrhage: Relationship of Cerebral Metabolism to Outcome." Journal of Neurosurgery, vol. 100, no. 3, 2004, pp. 400-6.
Sarrafzadeh A, Haux D, Küchler I, et al. Poor-grade aneurysmal subarachnoid hemorrhage: relationship of cerebral metabolism to outcome. J Neurosurg. 2004;100(3):400-6.
Sarrafzadeh, A., Haux, D., Küchler, I., Lanksch, W. R., & Unterberg, A. W. (2004). Poor-grade aneurysmal subarachnoid hemorrhage: relationship of cerebral metabolism to outcome. Journal of Neurosurgery, 100(3), 400-6.
Sarrafzadeh A, et al. Poor-grade Aneurysmal Subarachnoid Hemorrhage: Relationship of Cerebral Metabolism to Outcome. J Neurosurg. 2004;100(3):400-6. PubMed PMID: 15035274.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Poor-grade aneurysmal subarachnoid hemorrhage: relationship of cerebral metabolism to outcome. AU - Sarrafzadeh,Asita, AU - Haux,Daniel, AU - Küchler,Ingeborg, AU - Lanksch,Wolfgang R, AU - Unterberg,Andreas W, PY - 2004/3/24/pubmed PY - 2004/4/23/medline PY - 2004/3/24/entrez SP - 400 EP - 6 JF - Journal of neurosurgery JO - J. Neurosurg. VL - 100 IS - 3 N2 - OBJECT: The majority of patients with poor-grade subarachnoid hemorrhage (SAH), that is, World Federation of Neurosurgical Societies (WFNS) Grades IV and V, have high morbidity and mortality rates. The objective of this study was to investigate cerebral metabolism in patients with low- compared with high-grade SAH by using bedside microdialysis and to evaluate whether microdialysis parameters are of prognostic value for outcome in SAH. METHODS: A prospective investigation was conducted in 149 patients with SAH (mean age 50.9 +/- 12.9 years); these patients were studied for 162 +/- 84 hours (mean +/- standard deviation). Lesions were classified as low-grade SAH (WFNS Grades I-III, 89 patients) and high-grade SAH (WFNS Grade IV or V, 60 patients). After approval by the local ethics committee and consent from the patient or next of kin, a microdialysis catheter was inserted into the vascular territory of the aneurysm after clip placement. The microdialysates were analyzed hourly for extracellular glucose, lactate, lactate/pyruvate (L/P) ratio, glutamate, and glycerol. The 6- and 12-month outcomes according to the Glasgow Outcome Scale and functional disability according to the modified Rankin Scale were assessed. In patients with high-grade SAH, cerebral metabolism was severely deranged compared with those who suffered low-grade SAH, with high levels (p < 0.05) of lactate, a high L/P ratio, high levels of glycerol, and, although not significant, of glutamate. Univariate analysis revealed a relationship among hyperglycemia on admission, Fisher grade, and 12-month outcome (p < 0.005). In a multivariate regression analysis performed in 131 patients, the authors identified four independent predictors of poor outcome at 12 months, in the following order of significance: WFNS grade, patient age, L/P ratio, and glutamate (p < 0.03). CONCLUSIONS: Microdialysis parameters reflected the severity of SAH. The L/P ratio was the best metabolic independent prognostic marker of 12-month outcome. A better understanding of the causes of deranged cerebral metabolism may allow the discovery of therapeutic options to improve the prognosis, especially in patients with high-grade SAH, in the future. SN - 0022-3085 UR - https://www.unboundmedicine.com/medline/citation/15035274/Poor_grade_aneurysmal_subarachnoid_hemorrhage:_relationship_of_cerebral_metabolism_to_outcome_ L2 - https://thejns.org/doi/10.3171/jns.2004.100.3.0400 DB - PRIME DP - Unbound Medicine ER -