Correlation of Various Laboratory Parameters With Outcome in Patients Suffering From Acute Non-traumatic Subarachnoid Hemorrhage - Prospective Case Series
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 300
- 试验地点
- 1
- 主要终点
- mCLA
研究概览
简要总结
In this prospective study, the investigators aim to investigate the effect of the following three factors on the development of vasospasm and patient outcome: (1.) the role of anemia; (2.) the role of plasma fibrinolytic activity; (3.) the role of vitamin D.
The investigators include patients admitted to the Neurosurgical Intensive Care Unit of the Clinical Center of the University of Debrecen with the diagnosis of subarachnoid hemorrhage (SAH). Patients are treated according to international guidelines. As part of the study protocol the following investigations are performed: • Hemoglobin level measurement: on the day of admission and day 3-4-7 and 14 after hemorrhage •Modified clot lysis assay (mCLA): on the day of admission and day 7 after hemorrhage •25-hydroxy vitamin-D level measurement: on the day of admission •Transcranial color-coded duplex sonography (detecting vasospasm): on daily basis. •30 day follow-up: mortality, Glasgow Outcome Scale (GOS), Karnofsky score, Barthel score •90 day follow-up: mortality, Glasgow Outcome Scale , Karnofsky score, Barthel score. Laboratory test results are correlated with (a) the development of vasospasm; (b) with 30 and 90 day outcome.
Perspectives of the planned study: Considering the currently available therapeutic range for patients with SAH, results of the present study may provide a basis for designing further randomized, prospective trials to investigate the effect of treating anemia, anticoagulation and vitamin-D supplementation.
详细描述
Background
The incidence of aneurysmal subarachnoid hemorrhage is 10/100000 person/year. Some epidemiological date suggest that the 30-day mortality of subarachnoid hemorrhage (SAH) is nearly 50%. (ACROSS Group. Epidemiology of aneurysmal subarachnoid hemorrhage in Australia and New Zealand: incidence and case fatality from the Australasian Cooperative Research on Sub- arachnoid Hemorrhage Study (ACROSS). Stroke. 2000;31: 1843-50 Ingall T, Asplund K, Mahonen M, Bonita R. A multinational comparison of subarachnoid hemorrhage epidemiology in the WHO MONICA stroke study. Stroke. 2000;31:1054-61.). In this relative high mortality rate the effect of delayed cerebral ischaemia (DCI) and different extracerebral complications (Takotsubo cardiomyopathy, secondary infections, etc.) have key roles. (Claassen J, Vu A, Kreiter KT, et al. Effect of acute physiologic derangements on outcome after subarachnoid hemorrhage. Crit Care Med. 2004;32:832-8.). DCI occurs in nearly third of patients and its most common cause is cerebral vasospasm (at least 70% of cases). Vasospasm usually develops on day 3 after hemorrhage, it reaches a peak on day 7-8 and solves after the day 14.
(Dorsch NWC, King MT. A review of cerebral vasospasm in aneurysmal subarachnoid hemorrhage. Part 1: Incidence and effects. J Clin Neurosci. 1994;1:19-26.).
DCI has been shown to be a multifactorial process, in which cerebral vasospasm has a remarkable part, but anemia, cortical spreading depolarization, damage of cerebral autoregulation, and activation of the inflammatory-thrombotic cascade may also play an important role. . (Chamling B, Gross S, Stoffel-Wagner B, Schubert GA, Clusmann H, Coburn M, et al. Early diagnosis of delayed cerebral ischemia: possible relevance for inflammatory biomarkers in routine clinical practice? World Neurosurg (2017) 104:152-7. McBride DW, Blackburn SL, Peeyush KT, Matsumura K, Zhang JH. The Role of Thromboinflammation in Delayed Cerebral Ischemia after Subarachnoid Hemorrhage.Front Neurol. 2017;8:555.).
In this prospective study the investigators aim to investigate the role of the following three factors on the development of vasospasm and patient outcome: (1.) anemia; (2.) plasma fibrinolytic activity; (3.) vitamin D.
研究设计
- 研究类型
- Observational
- 观察模型
- Case Only
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •patients older than 18 years
- •admission within 48 hours after symptom onset
排除标准
- •admission over 48 hours after symptom onset
- •traumatic SAH
- •A-V malformation
- •Patient unable to consent and no relative available
结局指标
主要结局
mCLA
时间窗: day of admission, day 7 after hemorrhage
correlation with the development of vasospasm
25-hydroxy vitamin-D level
时间窗: day of admission
correlation with the development of vasospasm
Hemoglobin level
时间窗: day of admission, day 3-4-7 and 14 after hemorrhage
correlation with the development of vasospasm
次要结局
- mCLA(day 14, 30 and 90 after hemorrhage)
- 25-hydroxy vitamin-D level(day 14, 30 and 90 after hemorrhage)
- Hemoglobin level(day 14, 30 and 90 after hemorrhage)
研究者
Tamas Vegh, MD
associate professor
University of Debrecen