PREDICTIVE MARKER(S) OF SHORT-TERM PROGNOSIS AND MORTALITY RISK IN TRAUMATIC ACUTE SUBDURAL HEMATOMA PATIENTS AND STROKE PATIENTS AFTER DECOMPRESSIVE CRANIECTOMY

Öz

Objective: Decompressive craniectomy can reduce mortality in selected patients with stroke and traumatic acute subdural hematoma. This study aimed to explore predictive markers for short-term prognosis and mortality risk in patients who underwent decompressive craniectomy due to traumatic acute subdural hematoma or malignant middle cerebral artery occlusion using clinical, radiological, and routine blood biochemistry findings.

Material and Methods: Eleven traumatic acute subdural hematoma patients and 11 stroke patients were included in this study. On admission to hospital, for each patient, age, gender, Glasgow Coma Scale scores, anisocoria, time elapsed for decompressive craniectomy administration, midline shift level, duration of stay in Intensive Care Unit and in hospital, and Glasgow Outcome Scale scores on discharge from hospital and blood biochemistry findings were examined.

Results: The Glasgow Outcome Scale score was found 3.5 (2-5) in surviving patients and it was seen that short-term prognosis of patients could be associated with lymphocyte, neutrophil, and platelet count, neutrophil-lymphocyte ratio, and serum C-reactive protein level. However, mortality rate in both groups was found 77.2%, and it was thought that age, leukocyte, monocyte and platelet count, and serum blood urea nitrogen level could be associated with mortality risk.

Conclusion: As a result, it could be said that decompressive craniectomy could not reduce mortality risk in both groups. However, it was suggested that lymphocyte, neutrophil, and platelet counts, neutrophil-lymphocyte ratio, and serum C-reactive protein levels could be assumed as markers for short-term prognosis. Furthermore, it was concluded that age, leukocyte, monocyte, and platelet counts, and serum blood urea nitrogen levels could be predictors of mortality risk.

Anahtar Kelimeler

• Decompressive craniectomy
• traumatic acute subdural hematoma
• stroke
• short-term prognosis
• mortality risk

Travmatik Akut Subdural Hematom ve İnmelerde Dekompresif Kraniektomi Sonrası Kısa Dönem Prognoz ve Mortalite Riskinin Olası Belirteçleri

Öz

Amaç: Dekompresif kraniektomi, inme ve travmatik akut subdural hematom (TASH) bulunan seçilmiş hastalarda mortaliteyi azaltabilir. Bu çalışma, klinik, radyolojik ve rutin kan biyokimya bulguları kullanarak travmatik akut subdural hematom veya malign orta serebral arter oklüzyonu nedeniyle dekompresif kraniektomi uygulanan hastalarda kısa vadeli prognoz ve mortalite riski için öngörücü belirteçleri araştırmayı amaçladı.

Gereç ve Yöntemler: Bu çalışmaya 11 travmatik akut subdural hematom hastası ve 11 inme hastası dahil edildi. Hastaneye kabulde, her hasta için yaş, cinsiyet, Glasgow Koma Skalası skorları, anizokori, dekompresif kraniektomi uygulaması için geçen süre, orta hat kayma seviyesi, Yoğun Bakım Ünitesinde ve hastanede kalış süresi ve hastaneden taburculukta Glasgow Sonuç Ölçeği puanları ve kan biyokimya bulguları incelendi.

Bulgular: Yaşayan hastalarda Glasgow Sonuç Ölçeği skoru 3.5 (2-5) bulundu ve hastaların kısa dönem prognozunun lenfosit, nötrofil ve trombosit sayısı, nötrofil-lenfosit oranı ve C-reaktif protein ile ilişkili olabileceği görüldü. Ancak her iki grupta da ölüm oranı %77.2 olarak bulundu ve yaş, lökosit, monosit ve trombosit sayısı ile serum kan idrar nitrojen düzeyinin ölüm riski ile ilişkili olabileceği bulundu.

Sonuç: Sonuç olarak dekompresif kraniektominin her iki grupta da mortalite riskini azaltamadığı düşünüldü. Ancak lenfosit, nötrofil ve trombosit sayıları, nötrofil-lenfosit oranı ve serum C-reaktif protein düzeylerinin kısa dönem prognoz için öngörücü belirteç olarak kabul edilebileceği savunuldu. Ayrıca mortalite riskini öngörebilmede yaş, lökosit, monosit ve trombosit sayıları ile serum nitrojen düzeylerinin belirteçler olabileceği sonucuna varıldı.

Anahtar Kelimeler

• Dekompresif kraniektomi
• travmatik akut subdural hematom
• inme
• kısa dönem prognoz
• mortalite riski

Kaynakça

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