Risk factors for rebleeding of aneurysmal subarachnoid hemorrhage: a meta-analysis.

Chao Tang,Tian-Song Zhang,Liang-Fu Zhou,Jinglu Ai

doi:10.1371/journal.pone.0099536

Chao Tang, Tian-Song Zhang + Show 2 more

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https://doi.org/10.1371/journal.pone.0099536

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Abstract

BackgroundRebleeding is a serious complication of aneurysmal subarachnoid hemorrhaging. To date, there are conflicting data regarding the factors contributing to rebleeding and their significance.MethodsA systematic review of PubMed and Embase databases was conducted for studies pertaining to aneurysmal subarachnoid hemorrhage (aSAH) and rebleeding in order to assess the associated risk factors. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated from fourteen studies comprised of a total of 5693 patients that met the inclusion criteria.ResultsHigher rebleeding rates were observed < 6 h after the initial aSAH (OR = 3.22, 95% CI = 1.46–7.12), and were associated with high systolic blood pressure (OR = 1.93, 95% CI = 1.31–2.83), poor Hunt-Hess grade (III–IV) (OR = 3.43, 95% CI = 2.33–5.05), intracerebral or intraventricular hematomas (OR = 1.65, 95% CI = 1.33–2.05), posterior circulation aneurysms (OR = 2.15, 95% CI = 1.32–3.49), and aneurysms >10 mm in size (OR = 1.70, 95% CI = 1.35–2.14).ConclusionsAneurysmal rebleeding occurs more frequently within the first 6 hours after the initial aSAH. Risk factors associated with rebleeding include high systolic pressure, the presence of an intracerebral or intraventricular hematoma, poor Hunt-Hess grade (III-IV), aneurysms in the posterior circulation, and an aneurysm >10 mm in size.

Highlights

Rebleeding is a major and disabling complication of aneurysmal subarachnoid hemorrhages with high mortality and morbidity [1]
The criteria for inclusion of relevant studies were as follows: 1) reports of confirmed aneurysmal subarachnoid hemorrhages (aSAH) cases; 2) studies allowing for the extraction of odds ratios (OR) with the corresponding 95% confidence intervals (CI); 3) at least three articles referring to a given risk factor; 4) cohort or case-control studies or randomized controlled studies
A significantly increased rate for rebleeding was found,6 h after initial aSAH (OR = 3.22, 95% CI = 1.46–7.12)

Summary

Introduction

Rebleeding is a major and disabling complication of aneurysmal subarachnoid hemorrhages (aSAH) with high mortality and morbidity [1]. Factors associated with an increased risk for rebleeding include the time after initial aSAH [2,3,4,5,6,7], high systolic blood pressure [4,5,7,8], low Glasgow coma scale score [9], poor HuntHess grade [3,4,5,7,8,10,11,12,13], intracerebral or intraventricular hematomas [3,4,5,7,8,9,13,14], hemorrhage size [5,10,13,15], hemorrhage location [3,4,5,7,13,14,16], number of aneurysms [14], presence of a sentinel headache [12,14], early angiography [3,10,17], hyperglycemia [9], and levels of platelet sensitivity [3]. There are conflicting data regarding the factors contributing to rebleeding and their significance

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