後期高齢者のくも膜下出血における転帰規定因子

抄録

With aging of the population in Japan, the incidence of aneurysmal subarachnoid hemorrhage (SAH) has been increasing among the elderly. We analyzed the outcomes of SAH in patients over 75-years-old. We retrospectively evaluated medical records and imaging studies of 124 patients treated with clipping, coiling, or conservative therapy between January 2000 and December 2015. Patient ages ranged from 75 to 96 years (average, 80.4 years). Thirteen patients were male (10.5%). The patients were graded on admission according to the Hunt and Kosnik (H/K) scale, and the modified Rankin scale (mRS) at discharge.
Eighty-four patients (67.7%) underwent coil embolization, and 31 (25%) underwent surgical clipping. Nine patients (7.3%) received conservative therapy. The mortality rate of surgically treated patients was only 6.1%, even though the overall mortality rate was 10.5%. For assessment of factors related to outcomes, 115 surgically treated patients were divided into a good outcome group (mRS 0-2, n=43) and a poor outcome group (mRS 3-6, n=72). A preoperative low H/K grade of 1-3 was significantly associated with outcomes (95.3% in the good outcome group versus 55.6% in the poor outcome group, p<0.001). Findings of intracerebral hematoma, intraventricular hemorrhage, and acute hydrocephalus on initial computed tomography were also significantly associated with a poor outcome.
Radical surgical treatment resulted in low mortality and good outcomes, even in patients aged over 75-years-old, especially those with a low preoperative H/K grade.