Abstract-Text (inkl. Referenzen und Bildunterschriften)

Introduction-Delayed cerebral ischemia (DCI) is a major complication after spontaneous subarachnoid hemorrhage (SAH). Inflammation is an important factor contributing to the development of DCI. The sequential organ failure assessment (SOFA) score is used in intensive care medicine to monitor organ failure and predict mortality of sepsis, and presents a holistic picture of inflammatory processes. The objective of this study was to determine whether the SOFA score obtained in the first 48h post-SAH could be used to predict the occurrence of delayed cerebral infarctions after SAH.

Methods-We retrospectively evaluated all SAH patients admitted to our neurosurgical intensive care unit during a 10-year period. Patients were included if a cranial CT scan obtained 14-28 days post-SAH and clinical data were available to determine the SOFA scores, patient characteristics, Hunt&Hess score (H&H), and World Federation of Neurosurgical Societies score (WFNS). Cranial CT scans were evaluated for the occurrence of delayed cerebral infarctions by a neuroradiologist. The threshold to predict delayed cerebral infarctions was determined for each score to maximize the sum of sensitivity and specificity.

Results-488 patients were screened, 254 fulfilled the inclusion criteria. 69.7% were female, mean age was 57.0±12.5 years. Median SOFA score was 5, median H&H was 3, median WFNS was 3. The SOFA score was significantly associated with occurrence of DCI (p=0.0027) as well as H&H (p=0.023, OR=0.32) and WFNS (p=0.0035). The calculated threshold for the SOFA score was ≥ 7 points with a positive predictive value (PPV) of 0.92 and a negative predictive value (NPV) of 0.22, a sensitivity of 0.69 and a specificity of 0.59. The thresholds were ≥3 points for the H&H score (PPV 0.93, NPV 0.17, sensitivity 0.47, specificity 0.75), and ≥3 points for the WFNS score (PPV 0.94, NPV 0.18, sensitivity 0.55, specificity 0.73).

Conclusion-The SOFA score is regularly documented in intensive care medicine and therefore available for SAH patients treated on the ICU. SOFA score predicted the development of delayed cerebral infarctions with high NPV, similar to the established H&H and WFNS scores, while the predictive values were rather superior to the established scores. The SOFA score could therefore provide additional information to select patients at risk of delayed cerebral infarctions.