The Outcome Predictors of Malignant Large Infarction and the Functional Outcome of Survivors Following Decompressive Craniectomy

Tzu Kang Lin, Shu Mei Chen, Yin Cheng Huang, Pin Yuan Chen, Min Chi Chen, Hong Chieh Tsai, Tsong Hai Lee, Ko Ting Chen, Ming Hsueh Lee, Jen Tsung Yang, Kuo Lun Huang

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective Cerebral infarction is a common cause of disability. Malignant large infarction (MLI) is a catastrophic event, and there is no effective medical treatment. This study aimed to assess the outcome predictors of MLI and to analyze the impact of decompressive craniectomy (DC) on the functional outcome of survivors. Methods This study comprised 213 MLI cases. Outcome was evaluated with modified Rankin Scale (mRS) at 1-year follow-up, and various parameters were tested for MLI outcome predictors. The impact of DC on functional outcome was examined after being further stratified into good survival (mRS score = 0, 1, 2, 3), poor survival (mRS score = 4, 5), and mortality (mRS score = 6) groups. Results Standard medical treatment only was used in 106 cases, and both medical treatment and DC were used in 107 cases. With multiple logistic regression analysis, age, motor response at deterioration/operation, and DC were identified as independent outcome predictors of MLI (P = 0.027, P < 0.001, P < 0.001). Compared with the sole standard medical treatment, additional DC resulted in a better outcome (odds ratio [OR] =19.95; 95% confidence interval [CI], 7.61–52.27; P < 0.001). Further analysis of functional outcome revealed that DC significantly increased the chance of good survival as opposed to poor survival (OR = 20.04; 95% CI, 6.05–66.32; P < 0.001) and death (OR = 43.72; 95% CI, 13.21–144.72; P < 0.001). Conclusions In this study, DC performed on a young patient with motor response of localizing pain or better was linked with a better outcome. DC not only reduced mortality and increased the number of good survivals but also, most importantly, decreased the number of poor functional outcome survivals.

Original languageEnglish
Pages (from-to)133-138
Number of pages6
JournalWorld Neurosurgery
Volume93
DOIs
Publication statusPublished - Sep 1 2016

Fingerprint

Decompressive Craniectomy
Infarction
Survivors
Survival
Odds Ratio
Confidence Intervals
Mortality
Cerebral Infarction
Therapeutics
Logistic Models
Regression Analysis
Pain

Keywords

  • Decompressive craniectomy
  • Functional outcome
  • Malignant large infarction
  • Outcome predictor

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

The Outcome Predictors of Malignant Large Infarction and the Functional Outcome of Survivors Following Decompressive Craniectomy. / Lin, Tzu Kang; Chen, Shu Mei; Huang, Yin Cheng; Chen, Pin Yuan; Chen, Min Chi; Tsai, Hong Chieh; Lee, Tsong Hai; Chen, Ko Ting; Lee, Ming Hsueh; Yang, Jen Tsung; Huang, Kuo Lun.

In: World Neurosurgery, Vol. 93, 01.09.2016, p. 133-138.

Research output: Contribution to journalArticle

Lin, TK, Chen, SM, Huang, YC, Chen, PY, Chen, MC, Tsai, HC, Lee, TH, Chen, KT, Lee, MH, Yang, JT & Huang, KL 2016, 'The Outcome Predictors of Malignant Large Infarction and the Functional Outcome of Survivors Following Decompressive Craniectomy', World Neurosurgery, vol. 93, pp. 133-138. https://doi.org/10.1016/j.wneu.2016.06.005
Lin, Tzu Kang ; Chen, Shu Mei ; Huang, Yin Cheng ; Chen, Pin Yuan ; Chen, Min Chi ; Tsai, Hong Chieh ; Lee, Tsong Hai ; Chen, Ko Ting ; Lee, Ming Hsueh ; Yang, Jen Tsung ; Huang, Kuo Lun. / The Outcome Predictors of Malignant Large Infarction and the Functional Outcome of Survivors Following Decompressive Craniectomy. In: World Neurosurgery. 2016 ; Vol. 93. pp. 133-138.
@article{3f06db890f564af0a97c25e18d2eab98,
title = "The Outcome Predictors of Malignant Large Infarction and the Functional Outcome of Survivors Following Decompressive Craniectomy",
abstract = "Objective Cerebral infarction is a common cause of disability. Malignant large infarction (MLI) is a catastrophic event, and there is no effective medical treatment. This study aimed to assess the outcome predictors of MLI and to analyze the impact of decompressive craniectomy (DC) on the functional outcome of survivors. Methods This study comprised 213 MLI cases. Outcome was evaluated with modified Rankin Scale (mRS) at 1-year follow-up, and various parameters were tested for MLI outcome predictors. The impact of DC on functional outcome was examined after being further stratified into good survival (mRS score = 0, 1, 2, 3), poor survival (mRS score = 4, 5), and mortality (mRS score = 6) groups. Results Standard medical treatment only was used in 106 cases, and both medical treatment and DC were used in 107 cases. With multiple logistic regression analysis, age, motor response at deterioration/operation, and DC were identified as independent outcome predictors of MLI (P = 0.027, P < 0.001, P < 0.001). Compared with the sole standard medical treatment, additional DC resulted in a better outcome (odds ratio [OR] =19.95; 95{\%} confidence interval [CI], 7.61–52.27; P < 0.001). Further analysis of functional outcome revealed that DC significantly increased the chance of good survival as opposed to poor survival (OR = 20.04; 95{\%} CI, 6.05–66.32; P < 0.001) and death (OR = 43.72; 95{\%} CI, 13.21–144.72; P < 0.001). Conclusions In this study, DC performed on a young patient with motor response of localizing pain or better was linked with a better outcome. DC not only reduced mortality and increased the number of good survivals but also, most importantly, decreased the number of poor functional outcome survivals.",
keywords = "Decompressive craniectomy, Functional outcome, Malignant large infarction, Outcome predictor",
author = "Lin, {Tzu Kang} and Chen, {Shu Mei} and Huang, {Yin Cheng} and Chen, {Pin Yuan} and Chen, {Min Chi} and Tsai, {Hong Chieh} and Lee, {Tsong Hai} and Chen, {Ko Ting} and Lee, {Ming Hsueh} and Yang, {Jen Tsung} and Huang, {Kuo Lun}",
year = "2016",
month = "9",
day = "1",
doi = "10.1016/j.wneu.2016.06.005",
language = "English",
volume = "93",
pages = "133--138",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - The Outcome Predictors of Malignant Large Infarction and the Functional Outcome of Survivors Following Decompressive Craniectomy

AU - Lin, Tzu Kang

AU - Chen, Shu Mei

AU - Huang, Yin Cheng

AU - Chen, Pin Yuan

AU - Chen, Min Chi

AU - Tsai, Hong Chieh

AU - Lee, Tsong Hai

AU - Chen, Ko Ting

AU - Lee, Ming Hsueh

AU - Yang, Jen Tsung

AU - Huang, Kuo Lun

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Objective Cerebral infarction is a common cause of disability. Malignant large infarction (MLI) is a catastrophic event, and there is no effective medical treatment. This study aimed to assess the outcome predictors of MLI and to analyze the impact of decompressive craniectomy (DC) on the functional outcome of survivors. Methods This study comprised 213 MLI cases. Outcome was evaluated with modified Rankin Scale (mRS) at 1-year follow-up, and various parameters were tested for MLI outcome predictors. The impact of DC on functional outcome was examined after being further stratified into good survival (mRS score = 0, 1, 2, 3), poor survival (mRS score = 4, 5), and mortality (mRS score = 6) groups. Results Standard medical treatment only was used in 106 cases, and both medical treatment and DC were used in 107 cases. With multiple logistic regression analysis, age, motor response at deterioration/operation, and DC were identified as independent outcome predictors of MLI (P = 0.027, P < 0.001, P < 0.001). Compared with the sole standard medical treatment, additional DC resulted in a better outcome (odds ratio [OR] =19.95; 95% confidence interval [CI], 7.61–52.27; P < 0.001). Further analysis of functional outcome revealed that DC significantly increased the chance of good survival as opposed to poor survival (OR = 20.04; 95% CI, 6.05–66.32; P < 0.001) and death (OR = 43.72; 95% CI, 13.21–144.72; P < 0.001). Conclusions In this study, DC performed on a young patient with motor response of localizing pain or better was linked with a better outcome. DC not only reduced mortality and increased the number of good survivals but also, most importantly, decreased the number of poor functional outcome survivals.

AB - Objective Cerebral infarction is a common cause of disability. Malignant large infarction (MLI) is a catastrophic event, and there is no effective medical treatment. This study aimed to assess the outcome predictors of MLI and to analyze the impact of decompressive craniectomy (DC) on the functional outcome of survivors. Methods This study comprised 213 MLI cases. Outcome was evaluated with modified Rankin Scale (mRS) at 1-year follow-up, and various parameters were tested for MLI outcome predictors. The impact of DC on functional outcome was examined after being further stratified into good survival (mRS score = 0, 1, 2, 3), poor survival (mRS score = 4, 5), and mortality (mRS score = 6) groups. Results Standard medical treatment only was used in 106 cases, and both medical treatment and DC were used in 107 cases. With multiple logistic regression analysis, age, motor response at deterioration/operation, and DC were identified as independent outcome predictors of MLI (P = 0.027, P < 0.001, P < 0.001). Compared with the sole standard medical treatment, additional DC resulted in a better outcome (odds ratio [OR] =19.95; 95% confidence interval [CI], 7.61–52.27; P < 0.001). Further analysis of functional outcome revealed that DC significantly increased the chance of good survival as opposed to poor survival (OR = 20.04; 95% CI, 6.05–66.32; P < 0.001) and death (OR = 43.72; 95% CI, 13.21–144.72; P < 0.001). Conclusions In this study, DC performed on a young patient with motor response of localizing pain or better was linked with a better outcome. DC not only reduced mortality and increased the number of good survivals but also, most importantly, decreased the number of poor functional outcome survivals.

KW - Decompressive craniectomy

KW - Functional outcome

KW - Malignant large infarction

KW - Outcome predictor

UR - http://www.scopus.com/inward/record.url?scp=84976873457&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84976873457&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2016.06.005

DO - 10.1016/j.wneu.2016.06.005

M3 - Article

C2 - 27297245

AN - SCOPUS:84976873457

VL - 93

SP - 133

EP - 138

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -