Infarct volume predicts outcome after decompressive hemicraniectomy for malignant hemispheric stroke
| Autor: | Alexandra Pinczolits, Nils Hecht, Johannes Woitzik, Eric Jüttler, Peter Vajkoczy, Hermann Neugebauer, Ingo Fiss |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Brain Infarction Male medicine.medical_specialty Decompressive Craniectomy Hemispheric stroke 030204 cardiovascular system & hematology Logistic regression Disease-Free Survival 03 medical and health sciences 0302 clinical medicine Modified Rankin Scale Internal medicine Medicine Humans Prospective cohort study Stroke Aged Retrospective Studies Aged 80 and over business.industry Brain Neoplasms Age Factors Original Articles Middle Aged medicine.disease Clinical trial Survival Rate Neurology Infarct volume Cardiology Female Neurology (clinical) Neurosurgery Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery |
| Zdroj: | Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism. 38(6) |
| ISSN: | 1559-7016 |
| Popis: | The decision to perform decompressive hemicraniectomy (DHC) by default in malignant hemispheric stroke (MHS) remains controversial. Even under ideal conditions, DHC usually results in moderate to severe disability. The present study for the first time uses neuroimaging to identify independent outcome predictors in a prospective cohort of 96 MHS patients undergoing DHC. The primary outcome was functional status according to the modified Rankin Scale (mRS) at 12 months and categorized as favorable (mRS 0–3) or unfavorable (mRS 4–6). At 12 months, 19 patients (20%) reached favorable and 77 patients (80%) unfavorable outcome. The overall mean infarct volume was 328 ± 114 ml. Multivariable logistic regression identified age per year (OR 1.14, 95% CI 1.04–1.24; p = 0.005), infarct volume per cm3 (OR 1.012, 95% CI 1.003–1.022; p = 0.013), thalamic involvement (OR 8.65, 95% CI 1.04–72.15; p = 0.046) and postoperative pneumonia (OR 5.52, 95% CI 1.03–29.57; p = 0.046) as independent outcome predictors, which was confirmed by multivariable ordinal regression for age ( p = 0.004) and infarct volume ( p = 0.015). The infarct volume threshold for reasonable prediction of unfavorable outcome in our patients was 270 cm3, which in the future may help prognostication and development of clinical trials on DHC and outcome in MHS. |
| Databáze: | OpenAIRE |
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