[Early prognosis in chronic subdural hematomas. Multivariate analysis of 137 cases]. / Pronóstico precoz en hematomas subdurales crónicos. Análisis multivariante de 137 casos.

INTRODUCTION: In the literature there is evidence relating different factors such as age and preoperative clinical condition with prognosis in patients treated surgically for chronic subdural haematoma. OBJECTIVE: To clarify and quantify the magnitude of the factors which determine early prognosis (during hospital admission) of these patients. PATIENTS AND METHODS: We made a prospective study of 137 patients who had been operated on in our centre and found the relationship between different clinical and therapeutic variables with the clinical course and morbidity-mortality by means of multivariate and survival analysis. RESULTS: A high Markwalder functional score (3-4) is an independent factor of poor prognosis (OR = 13.15; CI 95% 6.1-28.4; p = 0.01), as is the presence of a coexisting coagulopathy (OR = 27.2; CI 95% 9.3-79.5; p = 0.01). Advanced age tended to increase the risk (OR = 1.104) but did not reach statistical significance (p = 0.0654). A multivariate logistic model, which included the functional score and presence of coagulopathy, correctly classified 94.7% of the cases studied. Analysis of survival showed two groups with different early mortality as a function of the Markwalder score (high: 3-4 and low: 0-1-2), which could be differentiated statistically (Log-Rank chi squared test: 3.95; p = 0.0468). CONCLUSIONS: The preoperative clinical state classified by functional scores and the presence of underlying coagulopathy are the main prognostic factors in chronic subdural haematoma during hospital admission. Advanced age is probably not in itself an independent factor for bad prognosis.

Pronóstico precoz en hematomas subdurales crónicos. Análisis multivariante de 137 casos / Early prognosis in chronic subdural haematomas multivariante analysis of 137 cases

Introduction. In the literature there is evidence relating different factors such as age and preoperative clinical condition with prognosis in patients treated surgically for chronic subdural haematoma. Objective. To clarify and quantify the magnitude of the factors which determine early prognosis (during hospital admission) of these patients. Patients and methods. We made a prospective study of 137 patients who had been operated on in our centre and found the relationship between different clinical and therapeutic variables with the clinical course and morbidity-mortality by means of multivariate and survival analysis. Results. A high Markwalder functional score (3-4) is an independent factor of poor prognosis (OR= 13.15; CI 95% 6.1-28.4; p= 0.01), as is the presence of a coexisting coagulopathy (OR= 27.2; CI 95% 9.3-79.5; p= 0.01). Advanced age tended to increase the risk (OR= 1.104) but did not reach statistical significance (p= 0.0654). A multivariate logistic model, which included the functional score and presence of coagulopathy, correctly classified 94.7% of the cases studied. Analysis of survival showed two groups with different early mortality as a function of the Markwalder score (high: 3-4 and low: 0-1-2), which could be differentiated statistically (Log-Rank chi squared test: 3.95; p= 0.0468). Conclusions. The preoperative clinical state classified by functional scores and the presence of underlying coagulopathy are the main prognostic factors in chronic subdural haematoma during hospital admission. Advanced age is probably not in itself an independent factor for bad prognosis (AU)

Introducción. Existen evidencias en la literatura que relacionan diversos factores, como la edad o el estado clínico preoperatorio, con el pronóstico del paciente intervenido quirúrgicamente porhematoma subdural crónico. Objetivo. Clarificar y cuantificar lamagnitud de aquellos factores que determinan el pronóstico precoz (durante el ingreso hospitalario) de dichos pacientes. Pacientes y métodos. Se estudiaron prospectivamente 137 pacientes intervenidosen nuestro centro y se relacionaron diversas variables clínicas y terapéuticas con la evolución clínica y morbimortalidad, mediante análisis multivariantes y de supervivencia. Resultados. Un grado funcional alto de Markwalder (3-4) es factor independiente de mal pronóstico (OR= 13,15; IC 95% 6,1-28,4; p= 0,01), así como la presencia decoagulopatía de base (OR= 27,2; IC 95%: 9,3-79,5; p= 0,01). La edad avanzada tiende a incrementar el riesgo (OR= 1,104), aunque sin significación estadística (p= 0,0654) El modelo logístico multivariante, que incluye el grado funcional y la presencia de coagulopatía, clasifica correctamente al 94,7% de los casos estudiados. El análisis de supervivencia extrajo dos grupos con distinta mortalidad precoz en función del grado de Markwalder (alto: 3-4, y bajo: 0-1-2), y estadísticamente diferenciables (χ2 del test de Log-Rank: 3,95; p= 0,0468). Conclusiones. El estado clínico prequirúrgico clasificado en grados funcionales y la presencia de coagulopatía de base son los principales factores pronósticos del hematoma subdural crónico durante el ingreso hospitalario. La edad avanzada per se probablemente no constituya un factor de mal pronóstico independiente (AU)