Systemic Severity and Organ Dysfunction in Subarachnoid Hemorrhage: A Large Retrospective Multicenter Cohort Study.

BACKGROUND AND PURPOSE: Acute physiologic derangements and multiple organ dysfunction are common after subarachnoid hemorrhage. We aimed to evaluate the simplified acute physiology score 3 (SAPS-3) and the sequential organ failure assessment (SOFA) scores for the prediction of in-hospital mortality in a large multicenter cohort of SAH patients. METHODS: This was a retrospective analysis of prospectively collected data from 45 ICUs in Brazil, during 2014 and 2015. Patients admitted with non-traumatic subarachnoid hemorrhage (SAH) were included. Clinical and outcome data were retrieved from an electronic ICU quality registry. SAPS-3 and SOFA scores, without the neurological components (i.e., nSAPS-3 and nSOFA, respectively) were recorded, as well as the World Federation of Neurological Surgeons (WFNS) scale. We used multilevel logistic regression analysis to identify factors associated with in-hospital mortality. We evaluated performance using the area under the receiver operating characteristic curve (AUROC), as well as calibration belts and precision-recall plots. RESULTS: The study included 997 patients, from which 426 (43%) had poor clinical grade (WFNS 4 or 5) and in-hospital mortality was 34%. Median nSAPS-3 and nSOFA score at admission were 46 (IQR: 38-55) and 2 (0-5), respectively. Non-survivors were older, had higher nSAPS-3 and nSOFA, and more often poor grade. After adjustment for age, poor grade and withdrawal of life sustaining therapies, multivariable analysis identified nSAPS-3 and nSOFA score as independent clinical predictors of in-hospital mortality. The AUROC curve that included nSAPS-3 and nSOFA scores significantly improved the already good discrimination and calibration of age and WFNS to predict in-hospital mortality (AUROC: 0.89 for the full final model vs. 0.85 for age and WFNS; P < 0.0001). CONCLUSIONS: nSAPS-3 and nSOFA scores were independently associated with in-hospital mortality after SAH. The addition of these scores improved early prediction of hospital mortality in our cohort and should be integrated to other specific prognostic indices in the early assessment of SAH.

Comparative study of root resorption of maxillary incisors in patients treated with lingual and buccal orthodontics.

OBJECTIVE: To compare the magnitude of external apical root resorption (EARR) of maxillary incisors in patients with mild to moderate anterior crowding, treated with lingual and conventional (labial) orthodontics. MATERIALS AND METHODS: The sample comprised 40 patients divided into two groups: lingual (20 patients) and conventional buccal brackets (20 patients). Patient ages ranged from 11 to 45 years, and the study included 12 men and 28 women. Apical root resorption was measured from periapical radiographs obtained at the beginning of treatment (T1) and at the end of the leveling phase (T2). Periapical radiographs were scanned and transferred to the CorelDraw X7 image-processing program, in which measurements of root lengths were performed. For intragroup and intergroup comparisons between the T1 and T2 phases, paired and independent t-tests, respectively, were used at 5% significance. RESULTS: There was significant apical root resorption for all teeth evaluated; the magnitude of the EARR (T2-T1) ranged from -0.35 mm to -0.63 mm in the lingual group, and from -0.66 mm to -0.85 mm in the conventional group. Although there was an intergroup variation in the magnitude of EARR observed, no statistically significant differences were found. Neither group presented any teeth with resorption ≥1 mm. CONCLUSIONS: The magnitude of apical root resorption in maxillary incisors in patients with anterior crowding was similar regardless of orthodontic technique, lingual or conventional. Both techniques resulting in an apical rounding considered clinically insignificant.