The Role of VASOGRADE as a Simple Grading Scale to Predict Delayed Cerebral Ischemia and Functional Outcome After Aneurysmal Subarachnoid Hemorrhage

Imagem de Miniatura
Arquivos
art_SOUZA_The_Role_of_VASOGRADE_as_a_Simple_Grading_2023.PDF (753.51 KB)
Citações na Scopus
5
Tipo de produção
article
Data de publicação
2023
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
HUMANA PRESS INC
Autores
ROUANET, Carolina
LIMA, Caio Vinicius Barroso de
SOUZA, Caio Augusto de
REZENDE, Flavio
ALVES, Maramelia Miranda
MANUEL, Airton Leonardo de Oliveira
NETO, Feres Chaddad
Citação
NEUROCRITICAL CARE, v.38, n.1, p.96-104, 2023
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background The VASOGRADE is a simple aneurysmal subarachnoid hemorrhage (aSAH) grading scale that combines the modified Fisher scale (mFisher) and the World Federation of Neurological Societies (WFNS) grading system, allowing the stratification of delayed cerebral ischemia (DCI) risk. However, the VASOGRADE accuracy in predicting functional outcomes is still to be determined. Methods We retrospectively evaluated a multiethnic cohort of consecutive patients with aSAH admitted to a high-volume center in Brazil from January 2016 to January 2019. Patients were classified according to the severity of the clinical presentation (WFNS), the amount of blood in the initial head computerized tomography (mFisher) scan, and the VASOGRADE (green, yellow, red). The primary outcome was to detect DCI-related cerebral infarction, and the secondary outcome was the functional outcome at hospital discharge according to the modified Rankin scale (mRs). Univariate and multivariate logistic regression models were employed. Results A total of 212 patients (71.7% female, mean age 52.7 +/- 12.8) were included. Sixty-nine patients were classified as VASOGRADE-Green (32.5%), 98 patients as VASOGRADE-Yellow (46.9%), and 45 patients as VASOGRADE-Red (20.6%). DCI-related infarction was present in 39 patients (18.9%). The proportions of patients in the VASOGRADE-Green, VASOGRADE-Yellow, and VASOGRADE-Red categories with DCI-related infarction were 7.7, 61.5, and 30.8%, respectively. After a multivariable analysis including age, sex, aneurysm location, and the VASOGRADE classification as variables, both VASOGRADE-Yellow and VASOGRADE-Red were independently associated with DCI-related infarction (odds ratio [OR] 7.69, 95% confidence interval [CI] 2.13-27.8, and OR 8.07, 95% CI 2.03-32.11, respectively) and unfavorable outcome (OR 4.16, 95% CI 1.33-13.03, and OR 25.57, 95% CI 4.45-147.1, respectively). The VASOGRADE discrimination performance for DCI-related infarction (area under the receiver operating characteristic curve) was 0.67 +/- 0.04 (95% CI 0.58-0.75; p = 0.001). VASOGRADE-Red had 97.5% specificity for predicting an unfavorable mRs score at discharge (95% CI 92.8-99.5%). Conversely, VASOGRADE-Green had an excellent specificity for predicting favorable outcome at discharge (mRs score 0-2, 95% CI 82.6-95.5%). Conclusions In conclusion, in a multiethnic cohort of patients with aSAH, VASOGRADE-Green predicted the absence of DCI and good clinical outcome at discharge with very high specificity, and patients in this category might be selected for early intensive care unit (ICU) discharge, minimizing costs and medical complications associated with prolonged hospital stay. On the other hand, patients categorized as VASOGRADE-Yellow and VASOGRADE-Red were at the highest risk for DCI. They should, therefore, be selected as a priority for care in high-volume aSAH centers, being aggressively monitored for DCI at the ICU. Such stratification methods are crucial, especially in countries with low financial resources and high health care services demand.
Palavras-chave
Aneurysmal subarachnoid hemorrhage, Delayed cerebral ischemia, VASOGRADE
URI
https://observatorio.fm.usp.br/handle/OPI/53246
Referências
  1. Buscot MJ, 2022, JAMA NETW OPEN, V5, DOI 10.1001/jamanetworkopen.2021.44039
  2. Collins GS, 2016, STAT MED, V35, P214, DOI 10.1002/sim.6787
  3. Crobeddu E, 2012, STROKE, V43, P697, DOI 10.1161/STROKEAHA.111.638403
  4. de Rooij NK, 2013, STROKE, V44, P1288, DOI 10.1161/STROKEAHA.113.001125
  5. Diringer MN, 2011, NEUROCRIT CARE, V15, P211, DOI 10.1007/s12028-011-9605-9
  6. Dumont TM, 2011, WORLD NEUROSURG, V75, P57, DOI 10.1016/j.wneu.2010.07.007
  7. Eagles ME, 2018, NEUROSURGERY, V82, P299, DOI 10.1093/neuros/nyx165
  8. Francoeur CL, 2016, CRIT CARE, V20, DOI 10.1186/s13054-016-1447-6
  9. Gonzalez NR, 2007, J NEUROSURG, V107, P1101, DOI 10.3171/JNS-07/12/1101
  10. Greving JP, 2014, LANCET NEUROL, V13, P59, DOI 10.1016/S1474-4422(13)70263-1
  11. KASSELL NF, 1990, J NEUROSURG, V73, P18, DOI 10.3171/jns.1990.73.1.0018
  12. Lannes M, 2012, NEUROCRIT CARE, V16, P354, DOI 10.1007/s12028-012-9701-5
  13. Macdonald RL, 2014, NAT REV NEUROL, V10, P44, DOI 10.1038/nrneurol.2013.246
  14. Magge SN, 2010, J NEUROSURG, V112, P1208, DOI 10.3171/2009.9.JNS081670
  15. Manoel ALD, 2016, CRIT CARE, V20, DOI 10.1186/s13054-016-1193-9
  16. Manoel ALD, 2015, STROKE, V46, P1826, DOI 10.1161/STROKEAHA.115.008728
  17. Mees SMD, 2012, J NEUROL, V259, P679, DOI 10.1007/s00415-011-6243-2
  18. Modi S, 2019, CLIN NEUROL NEUROSUR, V182, P167, DOI 10.1016/j.clineuro.2019.05.018
  19. Molyneux AJ, 2015, LANCET, V385, P691, DOI 10.1016/S0140-6736(14)60975-2
  20. Perry JJ, 2013, JAMA-J AM MED ASSOC, V310, P1248, DOI 10.1001/jama.2013.278018
  21. Rosen DS, 2005, NEUROCRIT CARE, V2, P110, DOI 10.1385/NCC:2:2:110
  22. Rouanet C, 2022, NEUROCRIT CARE, V36, P226, DOI 10.1007/s12028-021-01288-z
  23. Shea AM, 2007, NEUROSURGERY, V61, P1131, DOI 10.1227/01.neu.0000306090.30517.ae
  24. Torbey MT, 2001, STROKE, V32, P2005, DOI 10.1161/hs0901.094622
  25. Vergouwen MDI, 2010, STROKE, V41, P2391, DOI 10.1161/STROKEAHA.110.589275

Coleções
Artigos e Materiais de Revistas Científicas - HC/InRad
Artigos e Materiais de Revistas Científicas - LIM/45