16/06/2025
深淵なるニューロサイエンスへの旅 Vol. 110
A Voyage to Depth of Neuroscience Vol. 110
当科の柏崎大奈先生の論文がJ Clin Med誌に掲載されました。
脳血管攣縮による遅発性脳虚血(delayed cerebral ischemia; DCI)がくも膜下出血後の予後を決める重要な因子の一つであることは周知の事実です。今回の検討により、くも膜下出血直後に生じる全脳腫脹に経過中の感染症が加わると、DCIの発生リスクが急激に高まることが判明しました。くも膜下出血後の患者管理の際、留意すべき知見と考えます。
Infection Associated with Global Cerebral Edema and Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage
Kashiwazaki D, Maruyama K, Hamada S, Yamamoto S, Hori E, Akioka N, Noguchi K, Kuroda S.
J Clin Med. 2025 May 29;14(11):3808. doi: 10.3390/jcm14113808.
PMID: 40507570
https://pubmed.ncbi.nlm.nih.gov/40507570/
Abstract
Background/Objectives: Patients with aneurysmal subarachnoid hemorrhage (SAH) experience functional impairment due to early brain injury and delayed complications. We aimed to clarify the association between cerebral edema and post-SAH infection. We investigated whether this association leads to delayed cerebral ischemia (DCI) and poor clinical outcomes. Methods: We included 189 patients diagnosed with aneurysmal SAH at our institution. Demographic data and data on World Federation of Neurological Surgeons (WFNS) grade, modified Fisher grade, aneurysm location, treatment methods, global cerebral edema (GCE) assessed according to Subarachnoid Hemorrhage Early Brain Edema Score (SEBES), DCI, infection, duration of hospital stay, and modified Rankin Scale at 3 months were collected. Results: Overall, 88 patients (46.6%) developed GCE ([SEBES] 3 or 4), while 101 patients (53.4%) did not. DCI was observed in 58 (30.7%) patients. Infectious complications occurred in 80 (42.3%) patients. Kaplan-Meier analysis results suggested a higher frequency of DCI among patients with GCE and infection than those without (p < 0.01). Logistic regression analysis identified GCE (p < 0.001, odds ratio [OR] 3.3, 95% confidence interval [CI] [1.3-8.6]), older age (p = 0.02, OR 2.5, 95%CI [1.2-4.9]), higher WFNS grade (p = 0.01, OR 3.9, 95%CI [1.5-9.5]), and mechanical ventilation use (p = 0.04, OR 1.4, 95%CI [1.1-3.9]) as risk factors for infection, while age (p = 0.03, OR 2.3, 95%CI [1.1-4.6]), WFNS grade (p < 0.001, OR 4.5, 95%CI [1.5-9.2]), and GCE + infection (p < 0.001, OR 4.1, 95%CI [1.3-8.9]) were independent risk factors for DCI. Conclusions: GCE-infection linkage is associated with DCI, poor clinical outcomes, and longer hospital stays in patients with aneurysmal SAH. Therefore, the early brain injury (EBI)-infection-DCI chain plays an important role in the postsurgical management of these patients.