Procjena terapijskih mogućnosti u bolesnika s apscesom mozga [The estimation of therapeutical possibilities in patients with brain abscess]

Penezić, Ana (2016) Procjena terapijskih mogućnosti u bolesnika s apscesom mozga [The estimation of therapeutical possibilities in patients with brain abscess]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Background: The aim of the study was to define influence of different surgical methods and patients’ characteristics on the outcome using propensity score model. Methods: Demographic characteristics, microbiology, clinical presentation and treatment outcome were analyzed for surgically treated adult patients with brain abscess over a fourteen-year period. Propensity score model for standard craniotomy was calculated for each patient. The outcome was favourable if Glasgow Outcome Score (GOS) was 4 or 5 on the day of hospital discharge. Logistic regression analysis was performed to show which factors may influence the outcome in patients with brain abscess. Results: We analyzed 91 adult surgically treated patients, from which 53 had standard craniotomy and 38 stereotactic aspiration of brain abscess. Focal neurological deficit was the most common symptom present in 60 (65.9%) patients on admission. Sixty seven patients (73.6%) had a favourable outcome (GOS 4 and 5) and seven patients (7.7%) died during treatment. The choice of surgery did not influence the outcome (OR 1.181, 95% CI 0.349-3.995), neither did time from diagnosis to surgery (OR 0.998, 95% CI 0.981-1.015). Propensity toward standard craniotomy procedure had not influence outcome in brain abscess patients (OR 1.181, 95%CI 0.349-3.995) Worse outcome was independently associated with Glasgow Coma Score on admission (OR 0.787, CI 0.656-0.944). Conclusions: The choice of neurosurgical procedure does not influence the outcome in patients with brain abscess. Patients with brain abscess who have lower GCS on admission have worse outcome.

Abstract in Croatian

Uvod: Cilj naše studije bio je definirati utjecaj razliĉitih neurokirurških metoda na ishod bolesnika s apscesom mozga upotrebom propensity score modela. Metode: Analizirali smo ishod u neurokirurški lijeĉenih bolesnika s apscesom mozga, ispitujući utjecaj metode lijeĉenja i karakteristika bolesnika tijekom 14-godišnjeg razdoblja. Ishod je definiran kao povoljan ukoliko je Glasgowska ljestvica ishoda (GOS) pri otpustu bila 4 ili 5. Za svakog bolesnika smo izraĉunali vjerojatnost za standardnu kraniotomiju (propensity score). Izraĉunata je logistiĉka regresijska analiza koja je pokazala koji faktori utjeĉu na ishod u bolesnika s apscesom mozga. Rezultati: Analizirali smo podatke 91 neurokirurški lijeĉenog bolesnika: 53 lijeĉena standardnom kraniotomijom i 38 stereotaksijskom aspiracijom. Fokalni neurološki deficit bio je najĉešći simptom pri primitku prisutan u 60 bolesnika (65.9%). Šezdeset sedam bolesnika (73.6%) imali su povoljan ishod, a 7 je bolesnika umrlo tijekom lijeĉenja (7.7%). Izbor neurokirurškog zahvata nije utjecao na ishod kod bolesnika s apscesom mozga (OR 1.181, 95% CI 0.349-3.995, p=0.789), kao niti vrijeme od postavljanja dijagnoze do neurokirurškog zahvata (OR 0.998, 95% CI 0.981-1.015, p=0.825). Veća vjerojatnost za kraniotomiju takoĊer nije utjecala na ishod kod bolesnika (OR 1.181, 95%CI 0.349-3.995, p=0.097). Lošiji ishod bio je nezavisno povezan sa zbrojem Glasgowske ljestvice kome pri primitku (OR 0.787, CI 0.656-0.944, p=0.010). Zaključak: Izbor neurokirurškog zahvata ne utjeĉe na ishod bolesnika s apscesom mozga. Lošiji ishod imaju bolesnici s niţim GCS zbrojem pri hospitalizaciji. U retrospektivnim studijama, propensity score model moţe posloţiti za uklanjanje iskrivljenja u analizi ishoda bolesnika lijeĉenih razliĉitim terapijskim metodama.

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