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SYSTEMIC SEVERITY AND ORGAN DYSFUNCTION IN SUBARACHNOID HEMORRHAGE: A LARGE RETROSPECTIVE MULTICENTER COHORT STUDY
SOFA
Sequential organ failure assessment
Simplified acute physiology score 3
Subarachnoid hemorrhage
Author
Affilliation
Instituto Estadual do Cérebro Paulo Niemeyer. Rio de Janeiro, RJ, Brasil / Instituto D ́Or de Pesquisa e Educação. Rio de Janeiro, RJ, Brasil / Hospital Copa Star. Rio de Janeiro, RJ, Brasil.
Université Libre de Bruxelles. Dpt of Intensive Care, Hôpital Erasme. Brussels, Belgium.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Instituto D ́Or de Pesquisa e Educação. Rio de Janeiro, RJ, Brasil.
Pontifícia Universidade Católica do Rio de Janeiro. Rio de Janeiro, RJ, Brasil.
Instituto Estadual do Cérebro Paulo Niemeyer. Rio de Janeiro, RJ, Brasil.
Instituto Estadual do Cérebro Paulo Niemeyer. Rio de Janeiro, RJ, Brasil.
Instituto Estadual do Cérebro Paulo Niemeyer. Rio de Janeiro, RJ, Brasil.
Hospital Agenor Paiva. Salvador, BA, Brasil.
Hospital Santa Luzia. Brasilia, DF, Brasil.
Hospital São Francisco. Ribeirão Preto, SP, Brasil.
Hospital Nove de Julho. São Paulo, SP, Brasil.
Instituto D ́Or de Pesquisa e Educação. Rio de Janeiro, RJ, Brasil.
Instituto D ́Or de Pesquisa e Educação. Rio de Janeiro, RJ, Brasil / Universidade Federal do Rio de Janeiro. Programa de Pós-Graduação. Clínica Médica. Rio de Janeiro, RJ, Brasil.
Université Libre de Bruxelles. Dpt of Intensive Care, Hôpital Erasme. Brussels, Belgium.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Instituto D ́Or de Pesquisa e Educação. Rio de Janeiro, RJ, Brasil.
Pontifícia Universidade Católica do Rio de Janeiro. Rio de Janeiro, RJ, Brasil.
Instituto Estadual do Cérebro Paulo Niemeyer. Rio de Janeiro, RJ, Brasil.
Instituto Estadual do Cérebro Paulo Niemeyer. Rio de Janeiro, RJ, Brasil.
Instituto Estadual do Cérebro Paulo Niemeyer. Rio de Janeiro, RJ, Brasil.
Hospital Agenor Paiva. Salvador, BA, Brasil.
Hospital Santa Luzia. Brasilia, DF, Brasil.
Hospital São Francisco. Ribeirão Preto, SP, Brasil.
Hospital Nove de Julho. São Paulo, SP, Brasil.
Instituto D ́Or de Pesquisa e Educação. Rio de Janeiro, RJ, Brasil.
Instituto D ́Or de Pesquisa e Educação. Rio de Janeiro, RJ, Brasil / Universidade Federal do Rio de Janeiro. Programa de Pós-Graduação. Clínica Médica. Rio de Janeiro, RJ, Brasil.
Abstract
Background and purpose: Acute physiologic derangements and multiple organ dysfunction are common after subarachnoid hemorrhage. We aimed to evaluate the simplified acute physiology score 3 (SAPS-3) and the sequential organ failure assessment (SOFA) scores for the prediction of in-hospital mortality in a large multicenter cohort of SAH patients.
Methods: This was a retrospective analysis of prospectively collected data from 45 ICUs in Brazil, during 2014 and 2015. Patients admitted with non-traumatic subarachnoid hemorrhage (SAH) were included. Clinical and outcome data were retrieved from an electronic ICU quality registry. SAPS-3 and SOFA scores, without the neurological components (i.e., nSAPS-3 and nSOFA, respectively) were recorded, as well as the World Federation of Neurological Surgeons (WFNS) scale. We used multilevel logistic regression analysis to identify factors associated with in-hospital mortality. We evaluated performance using the area under the receiver operating characteristic curve (AUROC), as well as calibration belts and precision-recall plots.
Results: The study included 997 patients, from which 426 (43%) had poor clinical grade (WFNS 4 or 5) and in-hospital mortality was 34%. Median nSAPS-3 and nSOFA score at admission were 46 (IQR: 38-55) and 2 (0-5), respectively. Non-survivors were older, had higher nSAPS-3 and nSOFA, and more often poor grade. After adjustment for age, poor grade and withdrawal of life sustaining therapies, multivariable analysis identified nSAPS-3 and nSOFA score as independent clinical predictors of in-hospital mortality. The AUROC curve that included nSAPS-3 and nSOFA scores significantly improved the already good discrimination and calibration of age and WFNS to predict in-hospital mortality (AUROC: 0.89 for the full final model vs. 0.85 for age and WFNS; P < 0.0001).
Conclusions: nSAPS-3 and nSOFA scores were independently associated with in-hospital mortality after SAH. The addition of these scores improved early prediction of hospital mortality in our cohort and should be integrated to other specific prognostic indices in the early assessment of SAH.
Keywords
SAPS-3SOFA
Sequential organ failure assessment
Simplified acute physiology score 3
Subarachnoid hemorrhage
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