Predictors of the outcome in patients with poor-grade aneurysmal subarachnoid hemorrhage: a single center case series study

Abstract

Objective To investigate the predictors of the outcome in patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH). Methods The clinical data of patients with poor-grade aSAH (Hunt-Hess grade Ⅳ to Ⅴ) were analyzed retrospectively. The outcome evaluation was conducted with the Glasgow Outcome Scale (GOS) at 6 months after procedure, 4 to 5 were defined as good outcome and 1 to 3 were defined as poor outcome. Univariate analysis and multivariate logistic regression analysis were used to identify the factors influencing outcome. Results A total of 96 consecutive patients with poor-grade aSAH were enrolled, including 55 females and 41 males, aged from 18 to 80 years (mean, 61.2±11.4 years). The Hunt-Hess grade were Ⅳ in 47 and Ⅴ in 49 patients. Forty-one patients were treated with microsurgery clipping, 46 received conservative treatment. There were 32 patients (33.33%) in the good outcome group and 64 (66.67%)in the poor outcome group. Univariate analysis showed that the proportions of hypertension (40.6% vs. 65.6%; χ2=6.580, P=0.010), parenchymal hemorrhage (50.0% vs. 78.1%; χ2=8.836, P=0.003), and intraventricular hemorrhage or casted ventricles (34.4%vs. 68.8%; χ2=10.302, P=0.001), and signs of herniation (18.8% vs. 45.3%; χ2=6.497, P=0.013) in the good outcome group were significantly lower than those in the poor outcome group, while the proportions of Hunt-Hess grade Ⅳ (71.9% vs. 31.7%; χ2=10.088, P=0.001), aneurysm diameter <10 mm (84.4% vs. 45.3%; χ2=13.393, P<0.001), aneurysms at anterior communicating artery (53.1% vs. 29.7%; χ2=5.000, P=0.025), and active interventional treatment (operation of intervention) (93.8% vs. 31.3%; χ2=33.391, P<0.001) were significantly higher. Multivariate logistic regression analysis showed that hypertension (odds ratio [OR] 2.326, 95%confidence interval [CI] 3.037-15.331; P=0.023) and ventricular hemorrhage or casted ventricles (OR 3.274, 95% CI 2.156-5.311; P=0.020) were the independent risk factors for poor outcome in patients with poor-grade aSAH, and active interventional treatment was its independent protective factor (OR 0.04, 95% CI 0.003-0.565; P=0.017). Conclusions The prognosis in patients with poor-grade aSAH was closely associated with hypertension, ventricular casting, and treatment regimen. Key words: Subarachnoid Hemorrhage; Intracranial Aneurysm; Neurosurgical Procedures; Embolization, Therapeutic; Treatment Outcome; Risk Factors