The simplified acute physiology score to predict outcome in patients with subarachnoid hemorrhage.
OBJECTIVE
Current prognosticators for patients with subarachnoid hemorrhage (SAH) do not take into account signs of extracerebral organ dysfunction. This may explain the only moderate predictive value of these prognosticators. We assessed the prognostic value of the simplified acute physiology score (SAPS) II in SAH patients.


METHODS
In a retrospective cohort study of 148 consecutive SAH patients, we related the SAPS II calculated within 24 hours after admission to clinical and initial computed tomographic imaging characteristics using the Mann-Whitney U test. We compared the prognostic value of the SAPS II with that of the World Federation of Neurosurgical Surgeons score, the patient's age, and the amount of blood showing in computed tomographic imaging for the occurrence of delayed cerebral ischemia using Cox proportional hazards modeling or, for poor outcome (death or dependence), logistic regression modeling.


RESULTS
In the univariate analysis, the SAPS II was the strongest prognosticator; in the multivariate model, the SAPS II was the only independent predictor for outcome (odds ratio, 1.08; 95% confidence interval, 1.06-1.11]). Patients in the highest tertile of SAPS II had a significantly higher risk of poor outcome than those in the lowest tertile (odds ratio, 30.9; 95% confidence interval, 9.9-96.7]). The SAPS II was also the only independent predictor for the occurrence of delayed cerebral ischemia (hazard ratio, 1.020; 95% confidence interval, 1.002-1.039]).


CONCLUSIONS
The SAPS II is a useful and reliable prognosticator in SAH patients. This score may provide more information than specific SAH scales in predicting poor outcome or the occurrence of delayed cerebral ischemia in some circumstances.
Schuiling
Wouter Jan
WJ
Department of Neurology and Clinical Neurophysiology, Medical Center Haaglanden, Westeinde Hospital, Haaglanden, The Netherlands. wjschuiling@planet.nl
de Weerd
Al W
AW
Dennesen
Paul J W
PJ
Algra
Ale
A
Rinkel
Gabriël J E
GJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001794:Blood Pressure / Q000502:physiology; D001831:Body Temperature / Q000502:physiology; D015331:Cohort Studies; D005260:Female; D023261:Glasgow Outcome Scale; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007958:Leukocyte Count / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013223:Statistics as Topic; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods