Abstract

BackgroundThe prevalence of risk factors for poor outcomes from aneurysmal subarachnoid hemorrhage (SAH) varies widely and has not been fully elucidated to date in Vietnam. Understanding the risk and prognosis of aneurysmal SAH is important to reduce poor outcomes in Vietnam. The aim of this study, therefore, was to investigate the rate of poor outcome at 90 days of ictus and associated factors from aneurysmal SAH in the country.MethodsWe performed a multicenter prospective cohort study of patients (≥18 years) presenting with aneurysmal SAH to three central hospitals in Hanoi, Vietnam, from August 2019 to August 2020. We collected data on the characteristics, management, and outcomes of patients with aneurysmal SAH and compared these data between good (defined as modified Rankin Scale (mRS) of 0 to 3) and poor (mRS, 4–6) outcomes at 90 days of ictus. We assessed factors associated with poor outcomes using logistic regression analysis.ResultsOf 168 patients with aneurysmal SAH, 77/168 (45.8%) were men, and the median age was 57 years (IQR: 48–67). Up to 57/168 (33.9%) of these patients had poor outcomes at 90 days of ictus. Most patients underwent sudden-onset and severe headache (87.5%; 147/168) and were transferred from local to participating central hospitals (80.4%, 135/168), over half (57.1%, 92/161) of whom arrived in central hospitals after 24 hours of ictus, and the initial median World Federation of Neurological Surgeons (WFNS) grading score was 2 (IQR: 1–4). Nearly half of the patients (47.0%; 79/168) were treated with endovascular coiling, 37.5% (63/168) were treated with surgical clipping, the remaining patients (15.5%; 26/168) did not receive aneurysm repair, and late rebleeding and delayed cerebral ischemia (DCI) occurred in 6.1% (10/164) and 10.4% (17/163) of patients, respectively. An initial WFNS grade of IV (odds ratio, OR: 15.285; 95% confidence interval, CI: 3.096–75.466) and a grade of V (OR: 162.965; 95% CI: 9.975–2662.318) were independently associated with poor outcomes. Additionally, both endovascular coiling (OR: 0.033; 95% CI: 0.005–0.235) and surgical clipping (OR: 0.046; 95% CI: 0.006–0.370) were inversely and independently associated with poor outcome. Late rebleeding (OR: 97.624; 95% CI: 5.653–1686.010) and DCI (OR: 15.209; 95% CI: 2.321–99.673) were also independently associated with poor outcome.ConclusionsImprovements are needed in the management of aneurysmal SAH in Vietnam, such as increasing the number of aneurysm repairs, performing earlier aneurysm treatment by surgical clipping or endovascular coiling, and improving both aneurysm repairs and neurocritical care.

Highlights

  • Subarachnoid hemorrhage (SAH) is often a devastating event with high mortality, morbidity, and burden of healthcare [1, 2]

  • Most patients underwent sudden-onset and severe headache (87.5%; 147/ 168) and were transferred from local to participating central hospitals (80.4%, 135/168), over half (57.1%, 92/161) of whom arrived in central hospitals after 24 hours of ictus, and the initial median World Federation of Neurological Surgeons (WFNS) grading score was 2 (IQR: 1–4)

  • An initial WFNS grade of IV and a grade of V (OR: 162.965; 95% confidence interval (CI): 9.975–2662.318) were independently associated with poor outcomes

Read more

Summary

Introduction

Subarachnoid hemorrhage (SAH) is often a devastating event with high mortality, morbidity, and burden of healthcare [1, 2]. The mortality rate is approximately 50% in population-based studies with a trend towards gradual improvement [3,4,5]. This mortality rate includes 10–18% of all patients with aneurysmal SAH who die at home or during transportation to the hospital [6, 7]. Patients with aneurysmal SAH who are discharged alive from the hospital have an increased long-term mortality rate compared with the general population [11,12,13,14,15]. The prevalence of risk factors for poor outcomes from aneurysmal subarachnoid hemorrhage (SAH) varies widely and has not been fully elucidated to date in Vietnam. The aim of this study, was to investigate the rate of poor outcome at 90 days of ictus and associated factors from aneurysmal SAH in the country

Methods
Results
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call