Paired comparative study of risk factors related to aneurysm rupture during hospitalization

Abstract

Objective: Aneurysm rupture during in-hospital period contributes to the exceedingly high morbidity and mortality of inpatients with untreated aneurysm. However, risk factors for aneurysm rupture during hospitalization were scarcely focused in previous reports. The aim of this study was to investigate the risk factors of aneurysm rupture during hospitalization and to propose clinical strategies improving prognosis. Methods: Patients with intracranial aneurysm (lA) rupture during hospitalization were identified in our prospective cohort of consecutive patients admitted to Beijing Tiantan Hospital between Jan 2014 to Dec 2017. The ruptured cases were randomly paired with control cases without rupture during hospitalization (controlling age and gender) in a proportion of 1∶2 from the cohort. An observational comparative study was conducted between the two groups. Results: Tevelve cases with IAs rupture during hospitalization were identified among 4 429 cases with IAs. Twenty-four control cases were matched for gender (male∶female=5∶7) and age distribution. A history of pre-hospital aneurysm rupture was indicated as a risk factor for IA rupture during hospitalization (OR=8.333, 95% CI 1.480-46.936, P=0.011). The irregular shape (OR=10.133, 95% CI 1.941-52.902, P=0.005)and an inflow angle<60°(OR=41.800, 95% CI 4.311-405.335, P=0.000)were morphologic factors associated with IA rupture of inpatients. Conclusions: A history of pre-hospital IA rupture, IAs with irregular shape and an inflow angle <60° were risk factors associated with IAs rupture of inpatients. Unfavorable outcomes were observed in cases with IA rupture during hospitalization. A one-stage hybrid surgical strategy combining diagnosis, evaluation and intervention could reduce the length of preoperative stay, as well as the rupture risk of inpatients with IAs.