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

Yıl 2021, Cilt: 23 Sayı: 3, 492 - 504, 31.12.2021

Mustafa Öğden Bahar Say Ulaş Yüksel Alemiddin Özdemir Süleyman Akkaya Bülent Bakar

https://doi.org/10.24938/kutfd.946890

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

• 1. Wu S, Yuan R, Wang Y, Wei C, Zhang S, Yang X et al. Early prediction of malignant brain edema after ischemic stroke. Stroke. 2018;49(12):2918-27.
• 2. Aarabi B, Hesdorffer DC, Ahn ES, Aresco C, Scalea TM, Eisenberg HM. Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J Neurosurg. 2006;104(4):469-79.
• 3. Lazaridis C, Czosnyka M. Cerebral blood flow, brain tissue oxygen, and metabolic effects of decompressive craniectomy. Neurocrit Care. 2012;16(3):478-84.
• 4. Tian R, Liu W, Dong J, Zhang J, Xu L, Zhang B et al. Prognostic predictors of early outcomes and discharge status of patients undergoing decompressive craniectomy after severe traumatic brain injury. World Neurosurg. 2019;126:e101-e108.
• 5. Zweckberger K, Juettler E, Bösel J, Unterberg WA. Surgical aspects of decompression craniectomy in malignant stroke: review. Cerebrovasc Dis. 2014;38(5):313-23.
• 6. Bakar B, Sumer MM, Tekkok IH. Decompressive craniectomy for intractable intracranial hypertension. J Clin Anal Med. 2012;3(4):383-7.
• 7. Kim KT, Park JK, Kang SG, Cho KS, Yoo DS, Jang DK et al. Comparison of the effect of decompressive craniectomy on different neurosurgical diseases. Acta Neurochir (Wien). 2009;151(1):21-30.
• 8. Kalayci M, Aktunç E, Gül S, Hanci V, Edebali N, Cagavi F et al. Decompressive craniectomy for acute subdural hematoma: an overview of current prognostic factors and a discussion about some novel prognostic parameters. J Pak Med Assoc. 2013;63(1):38-49.
• 9. Altaf I, Shams S, Vohra AH. Role of surgical modality and timing of surgery as clinical outcome predictors following acute subdural hematoma evacuation. Pak J Med Sci. 2020;36(3):412-5.
• 10. Daou B, Kent AP, Montano M, Chalouhi N, Starke RM, Tjoumakaris S et al. Decompressive hemicraniectomy: predictors of functional outcome in patients with ischemic stroke. J Neurosurg. 2016;124(6):1773-9.
• 11. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2(7872):81-4.
• 12. McMillan T, Wilson L, Ponsford J, Levin H, Teasdale G, Bond M. The Glasgow outcome scale- 40 years of application and refinement. Nat Rev Neurol. 2016;12(8):477-85.
• 13. Chung J, Bang OY, Lim YC, Park SK, Shin YS. Newly suggested surgical method of decompressive craniectomy for patients with middle cerebral artery infarction. Neurologist. 2011;17(1):11-5.
• 14. Ho MY, Tseng WL, Xiao F. Estimation of the craniectomy surface area by using postoperative images. Int J Biomed Imaging. 2018;2018:5237693.
• 15. Karibe H, Hayashi T, Hirano T, Kameyama M, Nakagawa A, Tominaga T. Surgical management of traumatic acute subdural hematoma in adults: a review. Neurol Med Chir (Tokyo). 2014;54(11):887-94.
• 16. Pullicino PM, Alexandrov AV, Shelton JA, Alexandrova NA, Smurawska LT, Norris JW. Mass effect and death from severe acute stroke. Neurology. 1997;49(4):1090-5.
• 17. Agarwalla PK, Stapleton CJ, Ogilvy CS. Craniectomy in acute ischemic stroke. Neurosurgery. 2014;74(Suppl 1):S151-62.
• 18. Hofmeijer J, Kappelle LJ, Algra A, Amelink GJ, van Gijn J, van der Worp HB et al. Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol. 2009;8(4):326-33.
• 19. Jüttler E, Schwab S, Schmiedek P, Unterberg A, Hennerici M, Woitzik J et al. Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY): a randomized, controlled trial. Stroke. 2007;38(9):2518-25.
• 20. Vahedi K, Vicaut E, Mateo J, Kurtz A, Orabi M, Guichard JP et al. Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke. 2007;38(9):2506-17.