The Diagnostic Value of Near-Infrared Spectroscopy to Predict Delayed Cerebral Ischemia and Unfavorable Outcome After Subarachnoid Hemorrhage

J Joep van der Harst; Jan Willem J Elting; Reinoud P H Bokkers; Nic J G M Veeger; Carlina E van Donkelaar; Walter M van den Bergh; Jan D M Metzemaekers; Rob J M Groen; Aryan Mazuri; Gert-Jan R Luijckx; J Marc C van Dijk; Maarten Uyttenboogaart

doi:10.1016/j.wneu.2023.07.033

The Diagnostic Value of Near-Infrared Spectroscopy to Predict Delayed Cerebral Ischemia and Unfavorable Outcome After Subarachnoid Hemorrhage

World Neurosurg. 2023 Oct:178:e202-e212. doi: 10.1016/j.wneu.2023.07.033. Epub 2023 Jul 15.

Affiliations

¹ Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: j.j.van.der.harst@umcg.nl.
² Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
³ Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁴ Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁵ Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁶ Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁷ Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

PMID: 37454906
DOI: 10.1016/j.wneu.2023.07.033

Abstract

Objective: Near-infrared spectroscopy (NIRS) is a noninvasive tool to monitor cerebral regional oxygen saturation. Impairment of microvascular circulation with subsequent cerebral hypoxia during delayed cerebral ischemia (DCI) is associated with poor functional outcome after subarachnoid hemorrhage (SAH). Therefore, NIRS could be useful to predict the risk for DCI and functional outcome. However, only limited data are available on NIRS regional cerebral tissue oxygen saturation (rSO₂) distribution in SAH. The aim of this study was to compare the distribution of NIRS rSO₂ values in patients with nontraumatic SAH with the occurrence of DCI and functional outcome at 2 months. In addition, the predictive value of NIRS rSO₂ was compared with the previously validated SAFIRE grade (derived from Size of the aneurysm, Age, FIsher grade, World Federation of Neurosurgical Societies after REsuscitation).

Methods: In this study, the rSO₂ distribution of patients with and without DCI after SAH was compared. The optimal cutoff points to predict DCI and outcome were assessed, and its predictive value was compared with the SAFIRE grade.

Results: Of 41 patients, 12 developed DCI, and 9 had unfavorable outcome at 60 days. Prediction of DCI with NIRS had an area under the curve of 0.77 (95% confidence interval 0.62-0.92; P = 0.0028) with an optimal cutoff point of 65% (sensitivity 1.00; specificity 0.45). Prediction of favorable outcome with NIRS had an area under the curve of 0.86 (95% confidence interval 0.74-0.98; P = 0.0003) with an optimal cutoff point of 63% (sensitivity 1.00; specificity 0.63). Regression analysis showed that NIRS rSO₂ score is complementary to the SAFIRE grade.

Conclusions: NIRS rSO₂ monitoring in patients with SAH may improve prediction of DCI and clinical outcome after SAH.

Keywords: Delayed cerebral ischemia; Functional outcome; Modified Rankin scale; Near-infrared spectroscopy; SAFIRE grade; Subarachnoid hemorrhage; rSO(2).