Abstract
BackgroundPatients affected with aneurysmal subarachnoid hemorrhage (aSAH) often require intensive care, and then present distinctive outcome from less severe patients. We aimed to specify their long-term outcome and to identify factors associated with poor outcome.MethodsWe conducted a retrospective study in a French university hospital intensive care unit. Patients with aSAH requiring mechanical ventilation hospitalized between 2010 and 2015 were included. At least one year after initial bleeding, survival and degree of disability were assessed using the modified Rankin Scale (mRS) via telephone interviews. A multivariable logistic regression analysis was performed to determine independent factors associated with poor outcome defined as mRS≥3.ResultsTwo-hundred thirty-six patients were included. Among them, 7 were lost to follow-up, and 229 were analyzed: 73 patients (32%) had a good outcome (mRS<3), and 156 (68%) had a poor outcome (mRS≥3). The estimated 1-year survival rate was 63%. One-hundred sixty-three patients patients (71%) suffered from early brain injuries (EBI), 33 (14%) from rebleeding, 80 (35%) from vasospasm and 63 (27%) from delayed cerebral ischemia (DCI). Multivariable logistic regression identified independent factors associated with poor outcome including delay between aSAH diagnosis and mRS assessment (OR, 0.96; 95% CI, 0.95-0.98; p<.0001), age (OR per 10 points, 1.57; 95% CI, 1.12-2.19; p = 0.008), WFNS V versus WFNS III (OR, 5.71; 95% CI 1.51-21.61; p = 0.004), subarachnoid rebleeding (OR, 6.47; 95% CI 1.16-36.06; p = 0.033), EBI (OR, 4.52; 95% CI 1.81-11.29; p = 0.001) and DCI (OR, 4.73; 95% CI, 1.66-13.49; p = 0.004).ConclusionAmong aSAH patients requiring assisted ventilation, two-third of them survived at one year, and one-third showed good long-term outcome. As it appears as an independant factor associated with poor outcome, DCI shoud retain particular attention in future studies beyond angiographic vasospasm.
Highlights
Aneurysmal subarachnoid hemorrhage presented a stable incidence of 9-10/100 000 persons per year over the last decades [1, 2]
Multivariable logistic regression identified independent factors associated with poor outcome including delay between aneurysmal subarachnoid hemorrhage (aSAH) diagnosis and modified Rankin Scale (mRS) assessment (OR, 0.96; 95% confidence intervals (95% CI), 0.950.98; p
Among aSAH patients requiring assisted ventilation, two-third of them survived at one year, and one-third showed good long-term outcome
Summary
Aneurysmal subarachnoid hemorrhage (aSAH) presented a stable incidence of 9-10/100 000 persons per year over the last decades [1, 2]. The main determinant of poor outcome, usually defined as death or major disability, is the initial severity of the hemorrhage, estimated from clinical and radiological scores such as the one developed by the World Federation of Neurosurgeons (WFNS) [9,10,11,12]. Because of their critical condition, patients diagnosed with poor-grade aSAH (grade IV and V of the WFNS classification) are admitted in intensive care units (ICU) so that early brain injury (EBI), delayed cerebral ischemia (DCI), and other medical complications can be managed. We aimed to specify their long-term outcome and to identify factors associated with poor outcome
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