Dynamics of outcome after aneurysmal subarachnoid hemorrhage

Abstract

In this observational study, we analyzed and described the dynamics of the outcome after aneurysmal subarachnoid hemorrhage (SAH) in a collective of 203 cases. We detected a significant improvement of the mean aggregate modified Rankin Score (mRS) in every time interval from discharge to 6 months and up to 1 year. Every forth to fifth patient with potential of recovery (mRS 1-5) at discharge improved by 1 mRS point in the time interval from 6 month to 1 year (22.6%). Patients with mRS 3 at discharge had a remarkable late recovery rate (73.3%, p = 0.000085). Multivariate analysis revealed age ≤ 65 years (odds ratio 4.93; p = 0.0045) and "World Federation of Neurological Surgeons" (WFNS) grades I and II (odds ratio 4.77; p = 0.0077) as significant predictors of early improvement (discharge to 6 months). Absence of a shunting procedure (odds ratio 8.32; p = 0.0049) was a significant predictor of late improvement (6 months to 1 year), but not age ≤ 65 years (p = 0.54) and WFNS grades I and II (p = 0.92). Thus, late recovery (6 month to 1 year) is significant and independent from age and WFNS grade.

Impact of Age On Short-Term Outcomes After Discharge in Patients With Aneurysmal Subarachnoid Hemorrhage

“…Namely, mild neurological grade on admission was the factors improving outcomes. Hammer et al reported that WFNS grade I or II were signi cant factors of improvement from discharge to 6 months after onset (WFNS I-II vs. III-V: OR 4.77; 95% CI 1.51-15.05; p = 0.0077) in the multivariate analysis, [5] which supports our results.…”

“…The changes in the prevalence of good outcome (mRS score: 0-2 or Glasgow Outcome Score: 4-5) between discharge and the last follow-up ranged from 8.4-55.2%. [2,5,18,24,25,30] The prevalence of improvement of mRS scores in total cases between discharge and at 6 months ranged from 57.4-61.0%, [5,30] and the prevalence of declined mRS scores during the same period was 17.0%. [30]…”

“…As described in Table 4, Hammer et al reported that 116 of 202 patients (57.4%) had an improved mRS score between discharge and at 6 months. [5] According to Wilson et al's study, 88 cases of poor-grade aSAH were analyzed, and 61.0 % of patients had an improved mRS score between discharge and at 6 months. [30] Compared to these reports, our study shows lower prevalence (28.4%) of improved mRS scores.…”

“…[19] Although there are many reports examining the outcomes several months after onset of aSAH, [3, 4, 6, 8, 10-12, 15, 20, 21, 29] few reports have discussed the changes in the prevalence of outcome at discharge and after discharge in recent aging situation. [2,5,18,24,25,30] There are only two reports, to date, of changes in the outcome of individual patients after discharge. [5,30] According to these reports, approximately 60% of patients with aSAH had improved modi ed Rankin Scale (mRS) scores at 6 months after onset, and only one report mentioned scale grade or mWFNS scale grade at admission (n = 26), mRS score at discharge and 3 months after onset (n = 31), type of treatment (n = 18), location of the aneurysm (n = 21), pre-onset mRS score (n = 15), Fisher CT grade (n = 14), and cerebral VS category (n = 8).…”

“…[2,5,18,24,25,30] There are only two reports, to date, of changes in the outcome of individual patients after discharge. [5,30] According to these reports, approximately 60% of patients with aSAH had improved modi ed Rankin Scale (mRS) scores at 6 months after onset, and only one report mentioned scale grade or mWFNS scale grade at admission (n = 26), mRS score at discharge and 3 months after onset (n = 31), type of treatment (n = 18), location of the aneurysm (n = 21), pre-onset mRS score (n = 15), Fisher CT grade (n = 14), and cerebral VS category (n = 8). The remaining 1,111 patients were analyzed retrospectively (Fig.…”