Factors associated with clinical and radiological status on admission in patients with aneurysmal subarachnoid hemorrhage

Abstract

Grading scales yield objective measure of the severity of aneurysmal subarachnoid hemorrhage and serve as to guide treatment decisions and for prognostication. The purpose of this cohort study was to determine what factors govern a patient's disease-specific admission scores in a representative Central European cohort. The Swiss Study of Subarachnoid Hemorrhage includes anonymized data from all tertiary referral centers serving subarachnoid hemorrhage patients in Switzerland. The 2009-2014 dataset was used to evaluate the impact of patient and aneurysm characteristics on the patients' status at admission using descriptive and multivariate regression analysis. The primary/co-primary endpoints were the GCS and the WFNS grade. The secondary endpoints were the Fisher grade, the presence of a thick cisternal or ventricular clot, the presence of a new focal neurological deficit or cranial nerve palsy, and the patient's intubation status. In our cohort of 1787 consecutive patients, increasing patient age by 10 years and low pre-ictal functional status (mRS 3-5) were inversely correlated with "high" GCS score (GCS ≥ 13) (OR 0.91, 95% CI 0.84-0.97 and OR 0.67, 95% CI 0.31-1.46), "low" WFNS grade (grade VI-V) (OR 1.21, 95% CI 1.04-1.20 and OR 1.47, 95% CI 0.66-3.27), and high Fisher grade (grade III-IV) (OR 1.08, 95% CI 1.00-1.17 and OR 1.54, 95% CI 0.55-4.32). Other independent predictors for the patients' clinical and radiological condition at admission were the ruptured aneurysms' location and its size. In sum, chronological age and pre-ictal functional status, as well as the ruptured aneurysm's location and size, determine the patients' clinical and radiological condition at admission to the tertiary referral hospital.

The burden of headache following aneurysmal subarachnoid hemorrhage: a prospective single-center cross-sectional analysis

“…With respect to the above-mentioned preceding investigations, our patient sample is in line with the main epidemiological SAH characteristics and, therefore, representative. A total of 78.5% of our patients suffered from bleeding as a result of an aneurysm located at the anterior cerebral circulation with a mean aneurysm size of 5.9 ± 3.2 mm, which is in line with other studies [2,19,28,69]. The SAH severity distribution of the study population differed significantly from other surveys which generally give account of lower percentages of patients grouped into neurologically favorable low SAH grades [2,39].…”

“…Previous studies on SAH reported on average patient ages between 50 and 57 years with males in general being affected earlier [7,39,66,69]. Throughout the body of literature, females suffer more frequently from SAH than their male counterparts after their late thirties [39,69]. With respect to the above-mentioned preceding investigations, our patient sample is in line with the main epidemiological SAH characteristics and, therefore, representative.…”

“…Our SAH study collective presented with a mean age of 52.5 years and two out of three cases were of female gender. Previous studies on SAH reported on average patient ages between 50 and 57 years with males in general being affected earlier [7,39,66,69]. Throughout the body of literature, females suffer more frequently from SAH than their male counterparts after their late thirties [39,69].…”

Does aneurysm side influence the infarction side and patients´ outcome after subarachnoid hemorrhage?

“…Furthermore, a study published in 2018 showed, that the ´home- time´ for the first 90 days after SAH offers an easily applicable outcome measure for affected patients[13]. Zumofen et al [14] showed a correlation between chronological age, aneurysm location, aneurysm- size and pre- ictal functional status, and the influence on patients´ admission status and outcome. Other studies have described an influence on early infarctions and a therefore a worse outcome in affected patients[15].…”

Identification of inflammation‑associated circulating long non‑coding RNAs and genes in intracranial aneurysm rupture‑induced subarachnoid hemorrhage

“…intracranial aneurysm (ia) rupture-induced subarachnoid hemorrhage (SaH) is an acute, non-traumatic and devastating condition that accounts for ~5% of cerebrovascular strokes (1,2), and can result in 45% of mortality, 30% of disability and 50% of cognitive impairment morbidity cases in patients suffering from SAH (3)(4)(5)(6). Thus, understanding the molecular mechanism underlying ia rupture-induced systemic damage is critical for public health.…”