Could outcomes of intracranial aneurysms be better predict using serum creatinine and glomerular filtration rate?

Purpose: To analyze the role of serum creatinine levels as a biomarker of intracranial aneurysm outcomes. Methods: This is a prospective analysis of outcomes of patients with intracranial aneurysm. One hundred forty-seven patients with serum creatinine at admission and 6 months follow up were included. Linear and logistic regressions were used to analyze the data. Modified Rankin scale (mRS) was used to assess outcome. Results: Creatinine level was not directly related to aneurysm outcome nor aneurysm rupture (p > 0.05). However, patients with a glomerular filtration rate (GFR) lower than 72.50 mL·min­1 had an odds ratio (OR) of 3.049 (p = 0.006) for worse outcome. Similarly, aneurysm rupture had an OR of 2.957 (p = 0.014) for worse outcomes. Stepwise selection model selected 4 variables for outcomes prediction: serum creatinine, sex, hypertension and treatment. Hypertensive patients had, on average, an increase in 0.588 in mRS (p = 0.022), while treatment with microsurgery had a decrease in 0.555 (p = 0.038). Conclusions: Patients with higher GFR had better outcomes after 6 months. Patients with higher GFR had better outcomes after 6 months. Creatinine presented an indirect role in GFR values and should be included in models for outcome prediction.

Rastreo de aneurismas cerebrales en familiares de pacientes con hemorragia subaracnoidea / Tracking of cerebral aneurisms in of patients's familiars with subarachnoid hemorrhage

En el presente EOP se evalúa la conducta posible a seguir en el caso de familiares de primer grado de pacientes que padecieron una ruptura de un aneurisma cerebral con la consecuente hemorragia subaracnoidea. Se presenta el caso que motivó el EOP, se diseña la pregunta a ser respondida, así como la estrategia de búsqueda. Se analiza detalladamente el artículo considerado relevante para responderla, un estudio de intervención no controlado prospectivo de base poblacional, combinado con un análisis de decisión utilizando un modelo de tipo Markov. La ganancia de vida en promedio para todos los pacientes del grupo rastreo de 4 semanas de vida por paciente, y un número necesario a rastrear a cinco años de 894 familiares de primer grado para evitar una HSA y a 1.788 para evitar una HSA fatal. En base a estos resultados se concluye que al rastreo no estaría recomendado.