Editorial Comment—Prehemorrhage Risk Factors for Fatal Intracranial Aneurysm Rupture
Notice bibliographique
Résumé
Background and Purpose-The goal of this study was to investigate predictive preictal risk factors for fatal subarachnoid hemorrhage (SAH) in a patient population with verified intracranial aneurysms without surgical selection of patients and with complete follow-up.Methods-A total of 142 patients with 181 unruptured aneurysms diagnosed between 1956 and 1978 were followed up for a total of 2577 person-years until death, SAH, or the years 1997 to 2000.The predictive value of several factors known before SAH was tested for case fatality.Results-During follow-up, 34 first episodes of hemorrhage from a previously verified unruptured aneurysm occurred.Of these bleeding episodes, 17 were fatal.Patients who died after the bleeding had higher blood pressure values (meanϮSD, 148Ϯ11/92Ϯ8 mm Hg; mean pressure, 111Ϯ9 mm Hg) before hemorrhage than did those with nonfatal bleeding (meanϮSD, 135Ϯ15/83Ϯ11 mm Hg; mean, 101Ϯ12 mm Hg) (PϽ0.05).Patients with fatal SAH were also older (54Ϯ7 versus 47Ϯ13 years, Pϭ0.068) and had aneurysms larger in diameter (13Ϯ8 versus 10Ϯ5 mm) than those who survived.They had a higher prevalence of definite hypertension (56% versus 12%, PϽ0.05), more frequently used antihypertensive medication (29% versus 6%) by the end of follow-up, and tended to have higher blood pressure at the beginning of follow-up (140Ϯ21/85Ϯ11 versus 134Ϯ17/80Ϯ9 mm Hg).After adjustment for age, aneurysm size, and sex, the only indisputable significant independent risk factor for fatal SAH compared with nonfatal SAH was systolic blood pressure before aneurysm rupture (odds ratio, 1.11 per 1 mm Hg; 95% CI, 1.01 to 1.23; Pϭ0.032).The adjusted odds ratio of definite hypertension for fatal SAH was 12.67 (95% CI, 1.53 to 104.70; Pϭ0.018).Conclusions-Increased systolic blood pressure values and long-term hypertension before aneurysm rupture seem to predict fatal SAH independently of aneurysm size or patient age or sex at the time of rupture.(Stroke.2003;34:1852-1858.)Key Words: hypertension Ⅲ intracranial aneurysm Ⅲ natural history Ⅲ outcome Ⅲ subarachnoid hemorrhageA neurysmal subarachnoid hemorrhage (SAH), despite improvements in surgical and medical treatment, is a serious disease with high rates of mortality (40% to 50%) and morbidity.1,2 Outcome of SAH is still determined mainly by severity of initial bleed or early rebleeding 1-3 and, to a lesser extent, by delayed cerebral ischemia, commonly attributed to vasospasm in the large cerebral arteries.4 -6 Hence, identification of modifiable risk factors for SAH and for impaired outcome after the bleeding is important as a means to influence incidence and outcome of this serious disease.Indisputable modifiable risk factors for SAH seem to be cigarette smoking, alcohol consumption, and hypertension.[7][8][9][10] Besides severity of bleeding, outcome after SAH may be influenced by such preictal factors as patient age, 4,11-13 aneurysm site 4 and size (in surgical SAH cases), 4 history of hypertension, 11,13 and heavy alcohol drinking.11 Patient age, 4,12 aneurysm site, 4 and recent history of heavy alcohol consumption 11 (which is correlated with hypertension) have been reported independently of severity of SAH to
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,030 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,002 |
| Méta-épidémiologie (sens large) | 0,006 | 0,003 |
| Bibliométrie | 0,003 | 0,002 |
| Études des sciences et des technologies | 0,003 | 0,002 |
| Communication savante | 0,005 | 0,003 |
| Science ouverte | 0,004 | 0,001 |
| Intégrité de la recherche | 0,024 | 0,021 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,013 | 0,008 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».