Prognostic value of cerebral perfusion-computed tomography in the acute stage after subarachnoid hemorrhage for the development of delayed cerebral ischemia

• Published in: Stroke (1970) 2006-02, Vol.37 (2), p.409-413
• Main Authors: VAN DER SCHAAF, Irene, WERMER, Marieke J, VAN DER GRAAF, Yolanda, VELTHUIS, Birgitta K, VAN DE KRAATS, Clemens I. B, RINKEL, Gabriel J. E
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Area Under Curve; Biological and medical sciences; Brain Ischemia - pathology; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Neuropharmacology; Neuroprotective agent; Perfusion; Pharmacology. Drug treatments; Pilot Projects; Prognosis; Proportional Hazards Models; Prospective Studies; Sensitivity and Specificity; Subarachnoid Hemorrhage - diagnosis; Time Factors; Tomography, X-Ray Computed - methods; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.0000198831.69035.43

Delayed cerebral ischemia (DCI) is an important cause of death and disability after subarachnoid hemorrhage. We studied the additional prognostic value of brain perfusion to 3 established predictors (age, clinical condition on admission, and amount of subarachnoid blood) for the development of DCI. We included 69 patients scanned with perfusion--computed tomography within 72 hours after subarachnoid hemorrhage. For each patient, we determined cerebral blood flow (CBF) ratios of prespecified opposite regions of interest and the 3 established predictors. We calculated adjusted hazard ratios (HRs) for the CBF ratio and the 3 established predictors by means of multivariate analysis (Cox regression). The additional prognostic value of CBF ratios was assessed by comparing the area under the receiver operating characteristic curve (AUC) of 2 models: 1 with and 1 without addition of the CBF ratio to the 3 established predictors. The CBF ratio was an independent predictor for the development of DCI (HR, 0.63; 95% CI, 0.46 to 0.86) as was clinical condition (HR, 1.47; 95% CI, 1.01 to 2.13). By adding the CBF ratio to the model with the 3 established predictors, the AUC of the receiver operating characteristic curve increased from 0.76 (95% CI, 0.65 to 0.89) to 0.81 (95% CI, 0.71 to 0.91). This trend toward an increased AUC suggests an improved predictive value. The CBF ratio is an independent predictor for the development of DCI and can contribute to a better identification of patients at high risk for DCI.