Outcome Of Aneurysmal Subarachnoid Hemorrhage Research Articles

Predictors of Outcome of Aneurysmal Subarachnoid hemorrhage

Introduction: Aneurysmal Subarachnoid Hemorrhage (aSAH) is a devastating condition with high mortality and morbidity. Significant factors influencing the prognosis of aneurysmal subarachnoid hemorrhage (SAH) include the severity at presentation of the disease and delayed cerebral ischemia (DCI).
 Methods: This is a prospective study conducted in Upendra Devkota Memorial National Institute of Neurological and Allied Sciences (UDM-NINAS), Bansbari, Kathmandu, Nepal among patients who underwent clipping of aneurysm for subarachnoid hemorrhage. Various clinical and radiological prognostic factors were registered on admission and during the intensive care stay. Outcome was recorded. GOS>3 was considered good outcome and GOS ≤3 was considered poor outcome.
 Results: Seventy-two patients with ruptured aneurysm were surgically clipped. Good outcome was observed in 51 (70.83%) patients while poor outcome was seen among 21 (29.17%) patients including death among 16 (22.2%) patients. In univariate analysis, WFNS>2, Fisher grade >2, EVD placement for hydrocephalus and delayed cerebral ischemia (DCI) were found to have statistically significant in poor outcome. On Multivariate logistic regression model showed delayed cerebral ischemia was statistically significant predictor of poor outcome at p= 0.032 (OR= 7.34; 95% CI=1.280 to 17.702).
 Conclusion: WFNS >2, Fisher grade>2, EVD placement and DCI were found to have statistical significance in poor outcome while only DCI was an independent predictor of poor outcome following aneurysmal Subarachnoid Hemorrhage (aSAH).

The predictors of hyperglycemia and its effects on neurological outcome in the patients with aneurysmal subarachnoid hemorrhage undergoing surgical clipping: A prospective observational study.

Following intracranial aneurysm rupture, 70-90% of patients have hyperglycemia as a stressful response. Uncontrolled hyperglycemia is deleterious if not controlled well. The objectives of the study were to assess the prevalence, risk factors of hyperglycemia, and its effect on outcome in aneurysmal subarachnoid hemorrhage (aSAH) patients who underwent aneurysmal clipping. Following intracranial aneurysm rupture, 70-90% of patients have hyperglycemia as a stressful response. Uncontrolled hyperglycemia is deleterious if not controlled well. The objectives of the study were to assess the prevalence, risk factors of hyperglycemia, and its effect on outcome in aSAH patients who underwent aneurysmal clipping. At admission, the prevalence of hyperglycemia and severe hyperglycemia was 31.8% and 6.8%, respectively. Perioperative hyperglycemia and severe hyperglycemia were seen in 75.7% and 27%, respectively. History of diabetes mellitus (DM), higher admission random blood sugar, and higher admission mean blood pressure were predictors of perioperative hyperglycemia (P- 0.046, 0.00, and 0.004, respectively) and severe hyperglycemia (P- 0.048, 0.00, and 0.031). In addition, female sex, prolonged duration of anesthesia, and surgery were also found to be the predictors of hyperglycemia (P- 0.025, 0.07, and 0.012). Increased ventilator, intensive care unit, and hospital days were associated with perioperative hyperglycemia and severe hyperglycemia, respectively (P ≤ 0.006/0.00, P ≤ 0.007/0.00, and P ≤ 0.038/0.00). Poor Glasgow Outcome Score at 1 and 3 months after discharge was associated with admission and perioperative hyperglycemia ([P ≤ 0.000/0.000 and P ≤ 0.000/0.000], respectively). However, no association was seen between mortality and hyperglycemia or severe hyperglycemia. A higher prevalence of hyperglycemia is present in aSAH patients. A higher incidence of perioperative hyperglycemia is associated with poor neurological outcomes. Hence, the identification of risk factors and meticulous perioperative control of hyperglycemia will help in preventing poor neurological outcomes.

The elevation of different myocardial biomarkers on admission is associated with disease features and different outcomes in aneurysmal subarachnoid hemorrhage

Test of different myocardial biomarkers is commonly arranged in patients with aneurysmal subarachnoid hemorrhage (aSAH). We sought to figure out whether different myocardial biomarkers' elevation is related to characteristics of ruptured aneurysms and patients' clinical outcomes. Patients with aSAH admitted in the Neurosurgery Department of West China Hospital from September 2019 to March 2020 were screened. Those who have one clear responsible aneurysm and met inclusion criteria were included. Clinical characteristics, site and size of the aneurysm, modified Fisher scale, troponin T (TPN-T), creatine kinase MB (CK-MB), and myoglobin (Myo) levels at admission, clinical outcomes (3-month mRS) were collected and compared. The study included 124 patients. After multivariate logistic regression, Hunt & Hess grade (per unit grade, OR 1.68, 95% CI 1.14–2.49), the size of ruptured aneurysm (equal to or more than 7 mm, OR 3.07, 95% CI 1.32–7.10) was highly predictive of myocardial biomarker elevation. All three biomarkers (TPN-T, CK-MB, Myo) were associated with unfavorable prognoses. Higher mortality (37.2% vs. 18.6%, P = 0.036) and a lower rate of good outcomes (41.9% vs. 71.2%, P = 0.003) were observed in patients with any positive myocardial biomarkers at admission. The clinical outcomes of patients with positive troponin T and negative creatine kinase MB were especially unfavorable. Our study demonstrates that the degree of neurological injury and size of ruptured aneurysm are strong predictors of myocardial biomarkers elevation, the site of ruptured aneurysm may not be associated with heart injury after SAH. The outcomes of patients with different combinations of abnormal biomarker levels may have significant differences and deserve further study.

Elevated blood viscosity is associated with delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage

ObjectivesDelayed cerebral ischemia (DCI) is a contributing factor for poor clinical outcome in aneurysmal subarachnoid hemorrhage (aSAH). Blood viscosity can reflect flow resistance and dehydration status. Our study aimed to analyze the association between blood viscosity and DCI in patients with aSAH. MethodsIn this retrospective cohort, systolic blood viscosity (SBV) and diastolic blood viscosity (DBV) were measured at admission in patients with aSAH. Receiver operating characteristic curve analysis was used to assess the predictive values of SBV and DBV for DCI after aSAH. Univariate and multivariate logistic regression was performed to analyze the association between blood viscosity and the development of DCI. ResultsA total of 470 patients with aSAH were included in this study, and 184 (39.1%) patients had DCI. Optimal cut-off values of DBV and SBV were presented as 12.05 (cP) and 3.75 (cP), respectively. In addition, DBV has higher predictable value of DCI than SBV (DBV: area under the curve [AUC] 0.793; standard error [SE] 0.026; 95% CI 0.722–0.864; P < 0.001, and SBV: AUC 0.702; SE 0.040; 95% CI 0.624-0.781; P < 0.001). In multivariate logistic regression analysis, elevated DBV was a predicting factor for development of DCI (odds ratio: 1.60; 95% confidence interval: 1.32-2.58; P = 0.037). ConclusionsBlood viscosity is associated with development of DCI in patients with aSAH. Especially, DBV has a higher predictive value for the occurrence of DCI than SBV. Elevated DBV is a potential predicting factor for the occurrence of DCI.

Neutrophil to lymphocyte ratio predicting poor outcome after aneurysmal subarachnoid hemorrhage: A retrospective study and updated meta-analysis.

BackgroundThe relationship between neutrophil to lymphocyte ratio (NLR) and poor outcome of aneurysmal subarachnoid hemorrhage (aSAH) is controversial. We aim to evaluate the relationship between NLR on admission and the poor outcome after aSAH.MethodPart I: Retrospective analysis of aSAH patients in our center. Baseline characteristics of patients were collected and compared. Multivariate analysis was used to evaluate parameters independently related to poor outcome. Receiver operating characteristic (ROC) curve analysis was used to determine the best cut-off value of NLR. Part II: Systematic review and meta-analysis of relevant literature. Related literature was selected through the database. The pooled odds ratio (OR) and corresponding 95% confidence interval (CI) were calculated to evaluate the correlation between NLR and outcome measures.ResultsPart I: A total of 240 patients with aSAH were enrolled, and 52 patients had a poor outcome. Patients with poor outcome at 3 months had a higher admission NLR, Hunt & Hess score, Barrow Neurological Institute (BNI) scale score, Subarachnoid Hemorrhage Early Brain Edema Score (SEBES), and proportion of hypertension history. After adjustment, NLR at admission remained an independent predictor of poor outcome in aSAH patients (OR 0.76, 95% CI 0.69-0.83; P < 0.001). The best cut-off value of NLR in ROC analysis is 12.03 (area under the curve 0.805, 95% CI 0.735 - 0.875; P < 0.001). Part II: A total of 16 literature were included. Pooled results showed that elevated NLR was significantly associated with poor outcome (OR 1.31, 95% CI 1.14-1.49; P < 0.0001) and delayed cerebral ischemia (DCI) occurrence (OR 1.32, 95% CI 1.11-1.56; P = 0.002). The results are more reliable in large sample sizes, low NLR cut-off value, multicenter, or prospective studies.ConclusionElevated NLR is an independent predictor of poor outcome and DCI occurrence in aSAH.

Association of pre-admission antihypertensive agents and outcomes in aneurysmal subarachnoid hemorrhage

BackgroundDelayed cerebral ischemia (DCI) and poor functional outcome are common complications in patients who suffer from aneurysmal subarachnoid hemorrhage (aSAH). It has been proposed that pre-admission beta-blocker therapy may lower cerebral vasospasm (cVSP) risk after aSAH; however, this association with other antihypertensives is unknown. We sought to determine the association between antihypertensives and clinical outcomes in aSAH patients. MethodsWe performed a retrospective study on a prospectively collected cohort of consecutive patients with aSAH who were admitted to an academic center from 2016 to 2021. Association between pre-admission use of antihypertensives and patient outcomes was determined. Primary outcomes included DCI and poor functional outcome at 3 months after discharge defined as modified Rankin scale [mRS] 4–6. The secondary outcome was cVSP identified using transcranial Doppler (TCD). ResultsThe cohort consisted of 306 aSAH patients with mean age 57.1 (SD 13.6) years with 187 females (61 %). Although pre-admission use of beta-blockers (OR 0.40, 95 % CI 0.21–80, p = 0.02), calcium channel blockers (OR 0.43, 95 % CI 0.19–0.93, p = 0.035), and thiazide (OR 0.31, 95 % CI 0.11–0.86, p = 0.025) were associated with lower risk of cVSP in univariate analysis, we did not find any association in a multivariate model after adjusting for age. There was no association between any class of antihypertensives and DCI or functional outcome. ConclusionPre-admission use of antihypertensive agents may affect TCD findings, however, none of them appear to be independently associated with DCI or functional outcome. Larger prospective studies are needed to establish any potential association.

Higher intracranial pressure variability is associated with lower cerebrovascular resistance in aneurysmal subarachnoid hemorrhage

Higher intracranial pressure variability (ICPV) has been associated with a more favorable cerebral energy metabolism, lower rate of delayed ischemic neurologic deficits, and more favorable outcome in aneurysmal subarachnoid hemorrhage (aSAH). We have hypothesized that higher ICPV partly reflects more compliant and active cerebral vessels. In this study, the aim was to further test this by investigating if higher ICPV was associated with lower cerebrovascular resistance (CVR) and higher cerebral blood flow (CBF) after aSAH. In this observational study, 147 aSAH patients were included, all of whom had been treated in the Neurointensive Care (NIC) Unit, Uppsala, Sweden, 2012–2020. They were required to have had ICP monitoring and at least one xenon-enhanced computed tomography (Xe-CT) scan to study cortical CBF within the first 2 weeks post-ictus. CVR was defined as the cerebral perfusion pressure in association with the Xe-CT scan divided by the concurrent CBF. ICPV was defined over three intervals: subminute (ICPV-1m), 30-min (ICPV-30m), and 4 h (ICPV-4h). The first 14 days were divided into early (days 1–3) and vasospasm phase (days 4–14). In the vasospasm phase, but not in the early phase, higher ICPV-4h (β = − 0.19, p < 0.05) was independently associated with a lower CVR in a multiple linear regression analysis and with a higher global cortical CBF (r = 0.19, p < 0.05) in a univariate analysis. ICPV-1m and ICPV-30m were not associated with CVR or CBF in any phase. This study corroborates the hypothesis that higher ICPV, at least in the 4-h interval, is favorable and may reflect more compliant and possibly more active cerebral vessels.

External ventricular drain use is associated with functional outcome in aneurysmal subarachnoid hemorrhage

PurposeExternal ventricular drains (EVD) are commonly used in aneurysmal subarachnoid hemorrhage (aSAH) patients and can be life-saving by diverting cerebrospinal fluid. However, the overall relationship between EVD use and outcome is poorly understood.MethodsIn an exploratory analysis of an aSAH patient cohort, we examined EVD use in relation to modified Rankin Scale (mRS) at hospital discharge and at 6 months (unfavorable outcome = mRS > 2) using univariable and multivariable analyses.ResultsEVDs were placed in 31 of 56 (55.4%) patients and more often in women than men (66.7% vs 35.0%, p = 0.022) despite similar rates of hydrocephalus. Women had greater ICU [18 (13.5–25) vs 11.5 (6.5–18.5) days, p = 0.014] and hospital lengths of stay (LOS) [20.5 (16.5–34) vs 13.5 (10.5–27) days, p = 0.015] than men and greater mRS at discharge [4 (3–5) vs 3 (2–3.5), p = 0.011] although mRS at 6 months was similar. Patients with EVDs had longer ICU and hospital LOS and greater mRS at discharge [5 (3–6) vs 2 (2–3), p < 0.001] and at 6 months [4 (2–6) vs 1 (0–2), p = 0.001] than those without an EVD. In multivariable models, EVD use was associated with unfavorable 6-month outcome accounting for age, sex, and admission modified Fisher scale, but not in models adjusting for Hunt and Hess scale and World Federation of Neurological Surgeons scale.ConclusionIn an aSAH cohort, the use of EVDs was associated with female sex and longer LOS, and may be linked to functional outcomes at discharge and at 6 months, although these associations warrant further investigation.

Effects of frailty on postoperative clinical outcomes of aneurysmal subarachnoid hemorrhage: results from the National Inpatient Sample database

BackgroundThis study aimed to investigate the potential effect of preoperative frailty on postoperative clinical outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH).MethodsData of patients aged 18 years and older who were diagnosed with subarachnoid hemorrhage or intracerebral hemorrhage, underwent aneurysm repair surgical intervention from 2005 to 2014. A retrospective database analysis was performed based on U.S. National Inpatient Sample (NIS) from 2005 to 2014. Frailty was determined using the Johns Hopkins Adjusted Clinical Groups (ACG) frailty-defining diagnoses indicator. Patients were stratified into frail and non-frail groups and the study endpoints were incidence of postoperative complications and related adverse clinical outcomes.ResultsAmong 20,527 included aSAH patients, 2303 (11.2%) were frail and 18,224 (88.8%) were non-frail. Significant differences were found between frailty and non-frailty groups in the four clinical outcomes (all p < 0.05). Multivariate analysis showed that frailty was associated with significant higher risks of discharge to institutional care (aOR: 2.50, 95%CI: 2.10–2.97), tracheostomy or gastrostomy tube replacement (aOR: 4.41, 95%CI: 3.81–5.10) and postoperative complications (aOR: 3.29, 95%CI: 2.55–4.25) but a lower risk of death in hospital (aOR: 0.40, 95%CI: 0.33–0.49) as compared with non-frailty. Stratified analysis showed the impact of frailty on some of the outcomes were greater among patients younger than 65 years than their older counterparts.ConclusionsFrailty is significantly correlated with the increased risk of discharge to institutional care, tracheostomy or gastrostomy tube placement, and postoperative complications but with the reduced risk of in-hospital mortality outcomes after aneurysm repair. Frailty seems to have greater impact among younger adults than older ones. Baseline frailty evaluation could be applied to risk stratification for aSAH patients who were undergoing surgery.

ED BP Management for Subarachnoid Hemorrhage

To review most recent literature on management of blood pressure in acute aneurysmal subarachnoid hemorrhage (SAH) and provide practice recommendations for the emergency clinician. There is increased risk of aneurysmal rebleeding with systolic blood pressure (SBP) greater than 160mmHg in the acute setting. Avoiding large degrees of blood pressure variability improves clinical outcomes in aneurysmal SAH. Acute lowering of SBP to a range of 140-160mmHg decreases risk of rebleeding while also maintaining cerebral perfusion pressure (CPP) after aneurysmal rupture. Treatment with a short acting antihypertensive agent allows for rapid titration of blood pressure (BP) and reduces BP variability. Elevations in intracranial pressure occur commonly after SAH due to increased intracranial blood volume, cerebral edema, or development of hydrocephalus. Clinicians should be familiar with changes in cerebral autoregulation and effects on CPP when treating elevated BP, in order to mitigate the risk of secondary neurological injury.

Association of External Ventricular Drain Duration and Outcomes in Aneurysmal Subarachnoid Hemorrhage: a Single Center Study (P12-10.003)

Association of External Ventricular Drain Duration and Outcomes in Aneurysmal Subarachnoid Hemorrhage: a Single Center Study (P12-10.003)

An Association of Antiplatelet Use and Outcomes In Aneurysmal Subarachnoid Hemorrhage (S35.008)

An Association of Antiplatelet Use and Outcomes In Aneurysmal Subarachnoid Hemorrhage (S35.008)

Neutrophil-to-albumin ratio as a novel marker predicting unfavorable outcome in aneurysmal subarachnoid hemorrhage

Background and objectiveCompelling evidence shows that inflammation contributes to the development of aneurysmal subarachnoid hemorrhage (aSAH). Several studies have conducted in the recent past have revealed that the neutrophil-to-albumin ratio (NAR) is a new marker of inflammation. However, whether NAR can predict the prognosis of patients with aSAH has not been fully elucidated. Therefore, the aim of this study was to investigate the relationship between NAR and prognosis of aSAH. MethodsA total of 555 consecutive patients diagnosed with aSAH were retrospectively enrolled. The NAR was assessed for each patient upon admission. At the same time, the demographic and clinical parameters of patients were collected. The Glasgow Outcome Scale (GOS, a score of 1–3) at 3 months was used to evaluate disease outcomes. ResultsPatients with unfavorable outcomes at 3 months were considerably older, had high levels of intraventricular and subarachnoidal hemorrhage, exhibited severe clinical conditions at admission, developed in-hospital complications, such as pneumonia and delayed cerebral ischemia. At admission, the NAR for GOS scores 4–5 was median [IQR] 0.231 [0.177–0.288] whereas that for GOS score 1–3 was 0.349 [0.264–4.449]; p < 0.001. The analysis revealed that the NAR was independently associated with unfavorable outcomes in patients with aSAH after adjusting for potential confounding factors (risk ratio [95% CI] 3.554 [2.601–4.857] per 0.1-point increment; p < 0.001). Moreover, a NAR of 0.274 was determined to be the best cutoff threshold for distinguishing between favorable and unfavorable outcomes in ROC analyses (AUC [95% CI] 0.782 [0.740–0.823]; p < 0.001; GOS 3–5: NAR ≥ 0.274 134/247 [54.3%] vs NAR < 0.274 47/308 [15.3%]; p < 0.001). ConclusionThis study demonstrates that NAR may be a novel prognostic marker in patients with aSAH. Elevated NAR is an independent factor predicting unfavorable outcome in patients with aSAH.

Impact of COVID-19 Pandemic on Treatment Management and Clinical Outcome of Aneurysmal Subarachnoid Hemorrhage - A Single-Center Experience.

BackgroundPrevious studies reported decreased volumes of acute stroke admissions during the COVID-19 pandemic. We aimed to examine whether aneurysmal subarachnoid hemorrhage (aSAH) volumes demonstrated similar declines in our department. Furthermore, the impact of the pandemic on disease progression should be analyzed.MethodsWe conducted a retrospective study in the neurosurgical department of the university hospital Frankfurt including patients with the diagnosis of aSAH during the first year of the COVID pandemic. One year cumulative volume for aSAH hospitalization procedures was compared to the year before (03/2020 – 02/2021 vs. 03/2019 – 02/2020) and the last 5 pre-COVID-pandemic years (2015-2020). All relevant patient characteristics concerning family history, disease history, clinical condition at admission, active/past COVID-infection, treatment management, complications, and outcome were analyzed.ResultsCompared to the 84 hospital admissions during the pre-pandemic years, the number of aSAH hospitalizations (n = 56) declined during the pandemic without reaching significance. No significant difference in the analyzed patient characteristics including clinical condition at onset, treatment, complications, and outcome, between 56 patients with aSAH admitted during the COVID pandemic and the treated patients in the last 5 years in the pre-COVID period were found. In our multivariable analysis, we detected young age (p < 0.05; OR 4.2) and no existence of early hydrocephalus (p < 0.05; OR 0.13) as important factors for a favorable outcome (mRS ≤ 0–2) after aSAH during the COVID pandemic. A past COVID-infection was detected in young patients suffering from aSAH (Age <50years, p < 0.05; OR 10.5) with an increased rate of cerebral vasospasm after aSAH onset (p < 0.05; OR 26). Nevertheless, past COVID-infection did not reach significance as a high-risk factor for unfavorable outcomes.ConclusionThere was a relative decrease in the number of patients with aSAH during the COVID-19 pandemic. Despite the extremely different conditions of hospitalization, there was no impairing significant effect on the treatment and outcome of admitted patients with aSAH. A past COVID infection seemed to be an irrelevant limiting factor concerning favorable outcomes.

XGBoost Machine Learning Algorithm for Prediction of Outcome in Aneurysmal Subarachnoid Hemorrhage.

BackgroundPatients suffered aneurysmal subarachnoid hemorrhage (aSAH) usually develop poor survival and functional outcome. Evaluating aSAH patients at high risk of poor outcome is necessary for clinicians to make suitable therapeutical strategy. This study is conducted to develop prognostic model using XGBoost (extreme gradient boosting) algorithm in aSAH.MethodsA total of 351 aSAH patients admitted to West China hospital were identified. Patients were divided into training set and test set with ratio of 7:3 to testify the predictive value of XGBoost based prognostic model. Additionally, logistic regression model was also constructed and compared with XGBoost based model. Area under the receiver operating characteristic curve (AUC), sensitivity and specificity were calculated to evaluate the value of XGBoost and logistic regression.ResultsThere were 74 (21.1%) non-survivors and 148 (42.1%) patients with unfavorable functional outcome. Non-survivors had older age (p=0.025), lower Glasgow coma scale (GCS) (p<0.001), higher World Federation of Neurosurgical Societies WFNS score (p<0.001), mFisher score (p<0.001). The incidence of intraventricular hemorrhage (IVH) (p=0.025) and delayed cerebral ischemia (DCI) (p<0.001) was higher in non-survivors than survivors. The AUC of XGBoost model for predicting mortality and unfavorable functional outcome were 0.950 and 0.958, which were higher than 0.767 and 0.829 of logistic regression model.ConclusionXGBoost based model is more precise than logistic regression model in predicting outcome of aSAH patients. Using XGBoost prognostic model is helpful for clinicians to identify high-risk aSAH patients and therefore strengthen medical care.

Applying Quantitative Radiographic Image Markers to Predict Clinical Complications After Aneurysmal Subarachnoid Hemorrhage: A Pilot Study.

Accurately predicting clinical outcome of aneurysmal subarachnoid hemorrhage (aSAH) patients is difficult. The purpose of this study was to develop and test a new fully-automated computer-aided detection (CAD) scheme of brain computed tomography (CT) images to predict prognosis of aSAH patients. A retrospective dataset of 59 aSAH patients was assembled. Each patient had 2 sets of CT images acquired at admission and prior-to-discharge. CAD scheme was applied to segment intracranial brain regions into four subregions, namely, cerebrospinal fluid (CSF), white matter (WM), gray matter (GM), and leaked extraparenchymal blood (EPB), respectively. CAD then detects sulci and computes 9 image features related to 5 volumes of the segmented sulci, EPB, CSF, WM, and GM and 4 volumetrical ratios to sulci. Subsequently, applying a leave-one-case-out cross-validation method embedded with a principal component analysis (PCA) algorithm to generate optimal feature vector, 16 support vector machine (SVM) models were built using CT images acquired either at admission or prior-to-discharge to predict each of eight clinically relevant parameters commonly used to assess patients' prognosis. Finally, a receiver operating characteristics (ROC) method was used to evaluate SVM model performance. Areas under ROC curves of 16 SVM models range from 0.62 ± 0.07 to 0.86 ± 0.07. In general, SVM models trained using CT images acquired at admission yielded higher accuracy to predict short-term clinical outcomes, while SVM models trained using CT images acquired prior-to-discharge demonstrated higher accuracy in predicting long-term clinical outcomes. This study demonstrates feasibility to predict prognosis of aSAH patients using new quantitative image markers generated by SVM models.

Impact of beginning, duration, and severity of anemia on the outcome of aneurysmal subarachnoid hemorrhage

Impact of beginning, duration, and severity of anemia on the outcome of aneurysmal subarachnoid hemorrhage

Impact of COVID-19 pandemic on treatment management and clinical outcome of aneurysmal subarachnoid hemorrhage – A single center experience

Impact of COVID-19 pandemic on treatment management and clinical outcome of aneurysmal subarachnoid hemorrhage – A single center experience

Outcome of Aneurysmal Subarachnoid Hemorrhage in a Population‐Based Cohort: Retrospective Registry Study

Background Studies of aneurysmal subarachnoid hemorrhage report an association between higher patient volumes and better outcomes. In regions with dispersed settlement, this must be balanced against the advantages with shorter prehospital transport times and timely access. The aim of this study is to report outcome for unselected aneurysmal subarachnoid hemorrhage cases from a well‐defined rural population treated in a low‐volume neurosurgical center. Methods This is a retrospective, population‐based, observational cohort study from northern Norway (population 486 450). The University Hospital of North Norway provides the only neurosurgical service. We retrieved data for all aneurysmal subarachnoid hemorrhage cases (n=332) admitted during 2007 through 2019 from an institution‐specific register. The outcome measures were mortality rates and functional status assessed with the modified Rankin scale. Results The mean annual number of cases was 26 (range, 16–38) and the mean crude incidence rate 5.4 per 100 000 person‐years. Two hundred seventy‐nine of 332 (84%) cases underwent aneurysm repair, 158 (47.5%) with endovascular techniques and 121 (36.4%) with microsurgical clipping, while 53 (15.9%) did not. The overall mortality rate was 16.0% at discharge and 23.8% at 12 months. The proportion with a favorable outcome (modified Rankin scale scores 0–2) was 36.1% at discharge and 51.5% at 12 months. In subgroup analysis of cases who underwent aneurysm repair, the mortality rate was 4.7% at discharge and 11.8% at 12 months, and the proportion with a favorable outcome 42.3% at discharge and 59.9% at 12 months. Conclusions We report satisfactory outcomes after treatment of aneurysmal subarachnoid hemorrhage in a low‐volume neurosurgical department serving a rural population. This indicates a reasonable balance between timely access to treatment and hospital case volume

Association Between Glycemic Gap and In-hospital Outcomes in Aneurysmal Subarachnoid Hemorrhage.

Introduction: Glycemic gap (GG), as determined by the difference between glucose and the hemoglobin A1c (HbA1c)-derived estimated average glucose (eAG), is associated with poor outcomes in various clinical settings. There is a paucity of data describing GG and outcomes after aneurysmal subarachnoid hemorrhage (aSAH). Our main objectives were to evaluate the association of admission glycemic gap (aGG) with in-hospital mortality and with poor composite outcome and to compare aGG's predictive value to admission serum glucose. Secondary outcomes were the associations between aGG and neurologic complications including vasospasm and delayed cerebral ischemia following aSAH.Methods: We retrospectively reviewed 119 adult patients with aSAH admitted to a single tertiary care neuroscience ICU. Spearman method was used for correlation for non-normality of data. Area under the curve (AUC) for Receiver Operating Characteristic (ROC) curve was used to estimate prediction accuracy of aGG and admission glucose on outcome measures. Multivariable analyses were conducted to assess the value of aGG in predicting in-hospital poor composite outcome and death.Results: Elevated aGG at or above 30 mg/dL was identified in 79 (66.4%) of patients. Vasospasm was not associated with the elevated aGG. Admission GG correlated with admission serum glucose (r = 0.94, p < 0.01), lactate (r = 0.41, p < 0.01), procalcitonin (r = 0.38, p < 0.01), and Hunt and Hess score (r = 0.51, p < 0.01), but not with HbA1c (r = 0.02, p = 0.82). Compared to admission glucose, aGG had a statistically significantly improved accuracy in predicting inpatient mortality (AUC mean ± SEM: 0.77 ± 0.05 vs. 0.72 ± 0.06, p = 0.03) and trended toward statistically improved accuracy in predicting poor composite outcome (AUC: 0.69 ± 0.05 vs. 0.66 ± 0.05, p = 0.07). When controlling for aSAH severity, aGG was not independently associated with delayed cerebral ischemia, poor composite outcome, and in-hospital mortality.Conclusion: Admission GG was not independently associated with in-hospital mortality or poor outcome in a population of aSAH. An aGG ≥30 mg/dL was common in our population, and further study is needed to fully understand the clinical importance of this biomarker.