The Outcome Predictors of Malignant Large Infarction and the Functional Outcome of Survivors Following Decompressive Craniectomy.
OBJECTIVE
Cerebral infarction is a common cause of disability. Malignant large infarction (MLI) is a catastrophic event, and there is no effective medical treatment. This study aimed to assess the outcome predictors of MLI and to analyze the impact of decompressive craniectomy (DC) on the functional outcome of survivors.


METHODS
This study comprised 213 MLI cases. Outcome was evaluated with modified Rankin Scale (mRS) at 1-year follow-up, and various parameters were tested for MLI outcome predictors. The impact of DC on functional outcome was examined after being further stratified into good survival (mRS score = 0, 1, 2, 3), poor survival (mRS score = 4, 5), and mortality (mRS score = 6) groups.


RESULTS
Standard medical treatment only was used in 106 cases, and both medical treatment and DC were used in 107 cases. With multiple logistic regression analysis, age, motor response at deterioration/operation, and DC were identified as independent outcome predictors of MLI (P = 0.027, P < 0.001, P < 0.001). Compared with the sole standard medical treatment, additional DC resulted in a better outcome (odds ratio [OR] =19.95; 95% confidence interval [CI], 7.61-52.27; P < 0.001). Further analysis of functional outcome revealed that DC significantly increased the chance of good survival as opposed to poor survival (OR = 20.04; 95% CI, 6.05-66.32; P < 0.001) and death (OR = 43.72; 95% CI, 13.21-144.72; P < 0.001).


CONCLUSIONS
In this study, DC performed on a young patient with motor response of localizing pain or better was linked with a better outcome. DC not only reduced mortality and increased the number of good survivals but also, most importantly, decreased the number of poor functional outcome survivals.
Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan. Electronic address: tklin100@cgmh.org.tw.
Tzu-Kang
TK
Lin
Department of Neurosurgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Shu-Mei
SM
Chen
Department of Neurosurgery, Chang Gung Memorial Hospital-Chiayi, Chiayi, Taiwan.
Yin-Cheng
YC
Huang
Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.
Pin-Yuan
PY
Chen
Department of Public Health and Biostatistics Consulting Center, School of Medicine, Chang Gung University, Taoyuan, Taiwan.
Min-Chi
MC
Chen
Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.
Hong-Chieh
HC
Tsai
Stroke Center, Department of Neurology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.
Tsong-Hai
TH
Lee
Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.
Ko-Ting
KT
Chen
Department of Neurosurgery, Chang Gung Memorial Hospital-Chiayi, Chiayi, Taiwan.
Ming-Hsueh
MH
Lee
Department of Neurosurgery, Chang Gung Memorial Hospital-Chiayi, Chiayi, Taiwan.
Jen-Tsung
JT
Yang
Stroke Center, Department of Neurology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.
Kuo-Lun
KL
Huang
D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality* / Q000601:surgery*; D015984:Causality; D002544:Cerebral Infarction / Q000401:mortality* / Q000601:surgery*; D015897:Comorbidity; D056424:Decompressive Craniectomy / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D015995:Prevalence; D011379:Prognosis; D020127:Recovery of Function; D012307:Risk Factors; D015996:Survival Rate; D017741:Survivors / Q000706:statistics & numerical data; D013624:Taiwan; D016896:Treatment Outcome
Decompressive craniectomy; Functional outcome; Malignant large infarction; Outcome predictor